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General NPI Number Information
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NPI Number | 1679815559
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Entity Type | Organization
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Legal Business Name | PROSPER PEDIATRICS
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Dates
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Enumeration Date | 03/19/2013
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Last Update Date | 03/19/2013
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Provider Practice Location Address
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Address Line | 1825 FOSTER AVE SUITE 1JJ
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City | BROOKLYN
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State | NY
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Zip | 11230-1834
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Country | US
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Telephone | 718-421-9176
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Fax | 718-421-1539
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Provider Business Mailing Address
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Address Line | 1825 FOSTER AVE SUITE 1JJ
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City | BROOKLYN
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State | NY
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Zip | 11230-1834
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Country | US
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Telephone | 718-421-9176
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Fax | 718-421-1539
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. MAGALLY PROSPER
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Credential | MD
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Telephone | 718-421-9176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 189546
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License Number State | NY
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