MEDICARE: PEDS, INC

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	252Y00000X	Early Intervention Provider Agency		NY

General Provider Information

NPI Number	:	1063759207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDS, INC

Provider Business Mailing Address
First Line	:	8022 NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1345
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8022 NORTHERN BLVD
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1345
Country	:	US
Telephone Number	:	718-505-8855
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CLAUDIA HASBUN
Credential	:
Telephone Number	:	718-505-8855

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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