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General NPI Number Information
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NPI Number | 1437227865
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Entity Type | Organization
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Legal Business Name | WANTAGH PEDIATRIC PLLC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2415 JERUSALEM AVE
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City | N BELLMORE
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State | NY
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Zip | 11714
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Country | US
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Telephone | 516-221-5151
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Fax | 516-221-0566
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Provider Business Mailing Address
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Address Line | 2415 JERUSALEM AVE
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City | N BELLMORE
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State | NY
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Zip | 11714
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Country | US
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Telephone | 516-221-5151
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Fax | 516-221-0566
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER AXEL
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Credential | MD
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Telephone | 516-221-5151
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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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