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General NPI Number Information
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NPI Number | 1558714584
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Entity Type | Organization
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Legal Business Name | MOONLIGHT PEDIATRICS OF NYC, P.C.
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Dates
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Enumeration Date | 07/14/2016
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Last Update Date | 07/14/2016
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Provider Practice Location Address
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Address Line | 111 W 25TH ST
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City | NEW YORK
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State | NY
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Zip | 10001-7243
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Country | US
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Telephone | 800-750-8616
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Fax |
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Provider Business Mailing Address
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Address Line | 26 FIREMENS MEMORIAL DR SUITE 115
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City | POMONA
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State | NY
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Zip | 10970-3553
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KRYSTAL MCKENNA
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Credential |
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Telephone | 845-362-8400
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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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