Healthcare Provider Details

I. General information

NPI: 1407092257
Provider Name (Legal Business Name): NEIGHBORHOOD PEDIATRICS OF SI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 RICHMOND RD
STATEN ISLAND NY
10306-1937
US

IV. Provider business mailing address

3090 RICHMOND RD
STATEN ISLAND NY
10306-1937
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-1949
  • Fax: 718-351-2569
Mailing address:
  • Phone: 718-351-1949
  • Fax: 718-351-2569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number214867
License Number StateNY

VIII. Authorized Official

Name: DR. INNA KHVAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-351-1949