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General NPI Number Information
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NPI Number | 1407974579
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Entity Type | Organization
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Legal Business Name | NIGHT LITE PEDIATRIC CENTER, LLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 5900 S JOHN YOUNG PKWY
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City | ORLANDO
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State | FL
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Zip | 32839-3716
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Country | US
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Telephone | 407-398-6470
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Fax | 407-894-6872
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Provider Business Mailing Address
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Address Line | 1 HOLLOW LN STE 301
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1215
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Country | US
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Telephone | 516-207-7936
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Fax | 516-207-7936
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Authorized Official
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Title or Position | MANAGER CREDENTIALING/ENROLLMENT
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Name | DANIELLE MARIE LOPEZ
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Credential |
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Telephone | 516-207-7936
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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 | ME0061521
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License Number State | FL
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