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General NPI Number Information
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NPI Number | 1225330962
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE PEDIATRIC ENDOCRINOLOGY, PC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 4701 QUEENS BLVD STE 302
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1600
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Country | US
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Telephone | 718-707-3434
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Fax | 718-707-3435
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Provider Business Mailing Address
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Address Line | 4701 QUEENS BLVD STE 302
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1600
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Country | US
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Telephone | 718-707-3434
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Fax | 718-707-3435
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIREYA H GARCIA
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Credential | M.D.
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Telephone | 718-707-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number | 236478
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License Number State | NY
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