Healthcare Provider Details

I. General information

NPI: 1194767863
Provider Name (Legal Business Name): CHESTER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N BROADWAY SUITE F
WHITE PLAINS NY
10601-2214
US

IV. Provider business mailing address

15 N BROADWAY SUITE F
WHITE PLAINS NY
10601-2214
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-4422
  • Fax: 914-948-9536
Mailing address:
  • Phone: 914-948-4422
  • Fax: 914-948-9536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANIE KENNEDY
Title or Position: OFFICE MANAGER
Credential:
Phone: 914-948-4422