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General NPI Number Information
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NPI Number | 1902143886
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Entity Type | Organization
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Legal Business Name | PM PEDIATRICS OF SELDEN
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Dates
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Enumeration Date | 01/11/2013
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1130 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-3102
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Country | US
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Telephone | 631-696-5437
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Fax | 631-698-2049
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Provider Business Mailing Address
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Address Line | 1 HOLLOW LN
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1220
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Country | US
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Telephone | 516-869-0650
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Fax | 516-869-0655
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Authorized Official
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Title or Position | MANAGER CREDENTIALING/ENROLLMENT
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Name | DANIELLE MARIE LOPEZ
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Credential |
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Telephone | 516-207-7936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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