Healthcare Provider Details

I. General information

NPI: 1922885045
Provider Name (Legal Business Name): PEDIATRIC INTENSIVE CARE SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ETHAN ALLEN DR
SUFFERN NY
10901-1802
US

IV. Provider business mailing address

2 ETHAN ALLEN DR
SUFFERN NY
10901-1802
US

V. Phone/Fax

Practice location:
  • Phone: 718-218-5693
  • Fax:
Mailing address:
  • Phone: 718-218-5693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LOUISDON PIERRE
Title or Position: PRESIDENT
Credential: MD
Phone: 718-218-5693