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General NPI Number Information
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NPI Number | 1538332580
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Entity Type | Organization
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Legal Business Name | STAGES PEDIATRICS P.C.
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 128 FORT WASHINGTON AVE 1J
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City | NEW YORK
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State | NY
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Zip | 10032-4721
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Country | US
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Telephone | 917-519-9954
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Fax |
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Provider Business Mailing Address
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Address Line | 128 FORT WASHINGTON AVE 1J
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City | NEW YORK
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State | NY
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Zip | 10032-4721
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Country | US
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Telephone | 917-519-9954
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Fax |
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Authorized Official
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Title or Position | MD
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Name | CLOTILDE B PENA
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Credential | MD
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Telephone | 917-519-9954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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