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General NPI Number Information
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NPI Number | 1811014483
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Entity Type | Organization
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Legal Business Name | PEDIATRICS 2000AT 207 STREET PLLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 515 W 207TH ST
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City | NEW YORK
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State | NY
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Zip | 10034-2645
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Country | US
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Telephone | 212-544-7777
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Fax | 212-544-9660
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Provider Business Mailing Address
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Address Line | 515 W 207TH ST
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City | NEW YORK
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State | NY
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Zip | 10034-2645
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Country | US
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Telephone | 212-544-7777
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Fax | 212-544-9660
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUAN TAPIA MENDOZA
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Credential | MD
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Telephone | 212-544-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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