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General NPI Number Information
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NPI Number | 1558626515
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Entity Type | Organization
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Legal Business Name | HEALTHY CHILDREN PEDIATRIC MEDICINE,P.C.
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 12/27/2012
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Provider Practice Location Address
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Address Line | 1240 WALTON AVE ST 1
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City | BRONX
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State | NY
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Zip | 10452-8050
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Country | US
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Telephone | 718-588-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 1240 WALTON AVE ST 1
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City | BRONX
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State | NY
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Zip | 10452-8050
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Country | US
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Telephone | 718-588-0303
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Fax | 718-588-0302
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Authorized Official
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Title or Position | PHYSICIAN
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Name | GRECIA A MARTE
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Credential | M.D.
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Telephone | 347-426-6906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 239636
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License Number State | NY
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