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General NPI Number Information
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NPI Number | 1720565187
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Entity Type | Organization
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Legal Business Name | BAYSIDE PEDIATRICS PC
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 4223 212TH ST STE 1A
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City | BAYSIDE
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State | NY
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Zip | 11361-2987
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Country | US
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Telephone | 718-229-7337
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Fax | 718-229-7333
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Provider Business Mailing Address
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Address Line | 4223 212TH ST STE 1A
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City | BAYSIDE
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State | NY
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Zip | 11361-2987
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Country | US
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Telephone | 718-229-7337
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Fax | 718-229-7333
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | YOHAN PARK
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Credential | MD
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Telephone | 718-229-7337
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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 |
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License Number State |
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