Healthcare Provider Details

I. General information

NPI: 1477721678
Provider Name (Legal Business Name): WEST SAYVILLE PEDIATRICS N.P.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MONTAUK HWY
WEST SAYVILLE NY
11796-1801
US

IV. Provider business mailing address

1 MONTAUK HWY
WEST SAYVILLE NY
11796-1801
US

V. Phone/Fax

Practice location:
  • Phone: 631-589-6727
  • Fax: 631-244-2866
Mailing address:
  • Phone: 631-589-6727
  • Fax: 631-244-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberF380872
License Number StateNY

VIII. Authorized Official

Name: TERESA GUTHRIE
Title or Position: RN PNP/PRESIDENT
Credential:
Phone: 631-589-6727