MEDICARE: FIRST CHOICE PEDIATRICS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	237321	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043480593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE PEDIATRICS, PC

Provider Business Mailing Address
First Line	:	3347 91ST ST APT 1J
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1731
Country	:	US
Telephone Number	:	718-424-2332
Fax Number	:	718-424-2386

Provider Business Practice Location Address
First Line	:	3347 91ST ST APT 1J
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1731
Country	:	US
Telephone Number	:	718-424-2332
Fax Number	:	718-424-2386

Authorized Official
Title or Position	:	MD
Name	:	ELLA ZAVOLUNOVA
Credential	:
Telephone Number	:	718-424-2332

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/11/2008

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