Healthcare Provider Details

I. General information

NPI: 1750973368
Provider Name (Legal Business Name): PREMIER PEDIATRICS OF NEW YORK, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 VETERANS RD W STE 2C
STATEN ISLAND NY
10309-2504
US

IV. Provider business mailing address

7 MORTON ST
STATEN ISLAND NY
10306-1460
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-6000
  • Fax: 718-356-6267
Mailing address:
  • Phone: 917-922-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. LINDA TERESA DI TORO
Title or Position: CEO, PRESIDENT
Credential: MD
Phone: 718-356-6000