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General NPI Number Information
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NPI Number | 1427355791
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Entity Type | Organization
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Legal Business Name | NRI PEDIATRICS PC
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Dates
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Enumeration Date | 02/22/2011
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Last Update Date | 09/06/2013
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Provider Practice Location Address
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Address Line | 2140 MENDON RD SUITE 201
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City | CUMBERLAND
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State | RI
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Zip | 02864-3833
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Country | US
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Telephone | 401-334-5437
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Fax | 401-334-3571
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Provider Business Mailing Address
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Address Line | 2140 MENDON RD SUITE 201
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City | CUMBERLAND
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State | RI
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Zip | 02864-3833
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Country | US
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Telephone | 401-334-5437
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Fax | 401-334-3571
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Authorized Official
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Title or Position | DOCTOR
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Name | MICHELLE BORNSTEIN-BENNETT
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Credential | M.D.
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Telephone | 401-334-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | MD12301
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License Number State | RI
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