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General NPI Number Information
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NPI Number | 1982093944
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Entity Type | Organization
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Legal Business Name | FAMILY PEDIATRIC
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 2224 COLLIER AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-2637
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Country | US
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Telephone | 347-683-0924
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Fax | 516-596-8860
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Provider Business Mailing Address
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Address Line | 2224 COLLIER AVE
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-2637
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Country | US
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Telephone | 347-683-0924
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Fax | 516-596-8860
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | OLUWAKEMI OGUNDALU
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Credential | NURSE
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Telephone | 347-683-0924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 689977
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 689977
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 689977
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 689977
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 689977
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License Number State | NY
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