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General NPI Number Information
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NPI Number | 1134843600
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Entity Type | Organization
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Legal Business Name | PENINSULA PEDIATRICS
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 12105 ROCKAWAY BEACH BLVD
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1821
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Country | US
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Telephone | 646-553-4815
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Fax |
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Provider Business Mailing Address
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Address Line | 12105 ROCKAWAY BEACH BLVD
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-1821
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DANIELLE FLANIGAN
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Credential | MD
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Telephone | 917-692-4850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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