Healthcare Provider Details

I. General information

NPI: 1427355791
Provider Name (Legal Business Name): NRI PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 MENDON RD SUITE 201
CUMBERLAND RI
02864-3833
US

IV. Provider business mailing address

2140 MENDON RD SUITE 201
CUMBERLAND RI
02864-3833
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-5437
  • Fax: 401-334-3571
Mailing address:
  • Phone: 401-334-5437
  • Fax: 401-334-3571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMD12301
License Number StateRI

VIII. Authorized Official

Name: MICHELLE BORNSTEIN-BENNETT
Title or Position: DOCTOR
Credential: M.D.
Phone: 401-334-5437