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General NPI Number Information
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NPI Number | 1306353479
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Entity Type | Organization
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Legal Business Name | FOUR SEASONS PEDIATRICS, LLC
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 532 MOE RD
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City | CLIFTON PARK
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State | NY
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Zip | 12065-3822
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Country | US
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Telephone | 518-383-2425
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Fax | 518-383-3255
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Provider Business Mailing Address
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Address Line | 30 HENDRIK HUDSON WAY
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City | HALFMOON
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State | NY
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Zip | 12065-2672
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Country | US
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Telephone | 518-383-2425
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Fax | 518-383-3255
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Authorized Official
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Title or Position | OWNER
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Name | HARRY MILLER
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Credential |
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Telephone | 518-383-2425
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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 |
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