Healthcare Provider Details

I. General information

NPI: 1972844322
Provider Name (Legal Business Name): RICHMOND PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 RICHMOND AVE 1ST FL
STATEN ISLAND NY
10314-3916
US

IV. Provider business mailing address

2066 RICHMOND AVE 1ST FL
STATEN ISLAND NY
10314-3916
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-9001
  • Fax: 718-982-9008
Mailing address:
  • Phone: 718-982-9001
  • Fax: 718-982-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number181489
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number181489
License Number StateNY

VIII. Authorized Official

Name: DR. ARTHUR BUONASPINA
Title or Position: MD
Credential: MD
Phone: 718-982-9001