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General NPI Number Information
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NPI Number | 1639478340
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Entity Type | Organization
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Legal Business Name | BAYSIDE PEDIATRIC CARE P.C.
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 22116 UNION TPKE
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City | BAYSIDE
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State | NY
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Zip | 11364-3641
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Country | US
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Telephone | 718-465-5888
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Fax | 718-465-5889
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Provider Business Mailing Address
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Address Line | 22116 UNION TPKE
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City | BAYSIDE
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State | NY
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Zip | 11364-3641
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Country | US
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Telephone | 718-465-5888
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Fax | 718-465-5889
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LI-MIN YANG
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Credential | M.D.
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Telephone | 718-465-5888
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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 | 240002
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License Number State | NY
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