Healthcare Provider Details

I. General information

NPI: 1093717993
Provider Name (Legal Business Name): KIDS CARE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BOYLE RD STE 7
SELDEN NY
11784-1955
US

IV. Provider business mailing address

239 BOYLE RD STE 7
SELDEN NY
11784-1955
US

V. Phone/Fax

Practice location:
  • Phone: 631-698-0600
  • Fax: 631-698-2212
Mailing address:
  • Phone: 631-698-0600
  • Fax: 631-698-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: ANNA SCHWARTZ
Title or Position: DOCTOR GENERAL PARTNER
Credential: MD
Phone: 631-698-0600