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General NPI Number Information
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NPI Number | 1679974760
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Entity Type | Organization
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Legal Business Name | PREMIER PEDIATRICS CARE PC
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 72 FULTON AVE
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City | HEMPSTEAD
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State | NY
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Zip | 11550-3651
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Country | US
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Telephone | 516-564-2056
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Fax |
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Provider Business Mailing Address
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Address Line | 72 FULTON AVE
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City | HEMPSTEAD
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State | NY
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Zip | 11550-3651
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Country | US
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Telephone | 516-564-2056
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Fax | 516-564-2055
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. TANYA ELEANOR DUVIVIER
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Credential | D.O.
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Telephone | 51656542056
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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 | 237804
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License Number State | NY
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