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General NPI Number Information
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NPI Number | 1215205893
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Entity Type | Organization
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Legal Business Name | IN TOWN PEDIATRICS, PLLC
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 12/09/2011
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Provider Practice Location Address
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Address Line | 150 PURCHASE ST SUITE 8A
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City | RYE
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State | NY
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Zip | 10580-2141
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Country | US
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Telephone | 914-967-9000
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Fax | 914-967-9007
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Provider Business Mailing Address
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Address Line | 150 PURCHASE ST SUITE 8A
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City | RYE
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State | NY
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Zip | 10580-2141
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Country | US
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Telephone | 914-967-9000
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Fax | 914-967-9007
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELENA ERIKA GAZZOLA-KRAENZLIN
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Credential | MD
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Telephone | 914-967-9000
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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 | 040193
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 215407
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License Number State | NY
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