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General NPI Number Information
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NPI Number | 1679373518
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Entity Type | Organization
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Legal Business Name | NORTH FORK DEVELOPMENTAL PEDIATRICS, LLC
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 2921 S MERIDIAN RD
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City | MERIDIAN
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State | ID
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Zip | 83642-7961
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Country | US
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Telephone | 847-858-1340
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Fax |
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Provider Business Mailing Address
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Address Line | 1775 W STATE ST # 179
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City | BOISE
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State | ID
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Zip | 83702-3924
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Country | US
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Telephone | 847-858-1340
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. AMY FRANCIS
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Credential | DO
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Telephone | 847-858-1340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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