=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992768782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARKVIEW PEDIATRICS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 PITTSFORD VICTOR RD
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-3812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-383-1160
-----------------------------------------------------
Fax | 585-383-8945
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1050 PITTSFORD VICTOR RD
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-3812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-383-1160
-----------------------------------------------------
Fax | 585-383-8945
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | AMY LEVINN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 585-383-1160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------