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General NPI Number Information
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NPI Number | 1225049620
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Entity Type | Organization
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Legal Business Name | PINE STREET PEDIATRICS ASSOCIATES, P.C.
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 140 PINE ST STE 210
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City | KINGSTON
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State | NY
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Zip | 12401-4948
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Country | US
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Telephone | 845-331-4484
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Fax | 845-853-7106
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Provider Business Mailing Address
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Address Line | 140 PINE ST STE 210
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City | KINGSTON
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State | NY
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Zip | 12401-4948
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Country | US
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Telephone | 845-331-4484
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Fax | 845-853-7106
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | MS. JOANNE HENDRICKS
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Credential |
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Telephone | 845-331-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | NY
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