=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790080448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRICS ON HUDSON, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2011
-----------------------------------------------------
Last Update Date | 03/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 615 BROADWAY
-----------------------------------------------------
City | HASTINGS ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10706-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-963-1663
-----------------------------------------------------
Fax | 914-476-5373
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 615 BROADWAY
-----------------------------------------------------
City | HASTINGS ON HUDSON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10706-1039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-963-1663
-----------------------------------------------------
Fax | 914-476-5373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID SIEGLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 914-963-1663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------