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General NPI Number Information
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NPI Number | 1285904789
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Entity Type | Organization
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Legal Business Name | DYNASTY PEDIATRICS PLLC
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Dates
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Enumeration Date | 12/31/2011
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Last Update Date | 12/31/2011
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Provider Practice Location Address
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Address Line | 464 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11218-5003
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Country | US
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Telephone | 718-282-0022
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Fax |
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Provider Business Mailing Address
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Address Line | 464 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11218-5003
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Country | US
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Telephone | 718-282-0022
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. MARINA KLOTSMAN
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Credential | DO
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Telephone | 718-282-0022
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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 | 244633
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License Number State | NY
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