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General NPI Number Information
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NPI Number | 1962552802
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Entity Type | Organization
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Legal Business Name | ST. NICHOLAS PEDIATRICS, PC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1559 SAINT NICHOLAS AVE
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City | NEW YORK
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State | NY
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Zip | 10040-4261
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Country | US
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Telephone | 212-928-8188
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Fax | 212-929-8040
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Provider Business Mailing Address
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Address Line | 3230 156TH ST
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City | FLUSHING
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State | NY
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Zip | 11354-3326
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Country | US
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Telephone | 212-928-8188
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Fax | 212-928-8040
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Authorized Official
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Title or Position | OWNER
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Name | HECTOR ANTONIO VALENCIA
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Credential | M.D.
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Telephone | 212-928-8188
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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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