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General NPI Number Information
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NPI Number | 1700165487
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Entity Type | Organization
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Legal Business Name | HOLLIS PEDIATRICS
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 18911 JAMAICA AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2513
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Country | US
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Telephone | 718-776-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 18911 JAMAICA AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2513
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Country | US
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Telephone | 718-776-1100
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Fax | 718-520-8688
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. ARKADIY TAKALOV
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Credential | M.D
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Telephone | 718-776-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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