MEDICARE: KIDS CARE PEDIATRICS

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		NY

General Provider Information

NPI Number	:	1093717993
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDS CARE PEDIATRICS

Provider Business Mailing Address
First Line	:	239 BOYLE RD
Second Line	:	STE 7
City	:	SELDEN
State	:	NY
Zip	:	11784-1955
Country	:	US
Telephone Number	:	631-698-0600
Fax Number	:	631-698-2212

Provider Business Practice Location Address
First Line	:	239 BOYLE RD
Second Line	:	STE 7
City	:	SELDEN
State	:	NY
Zip	:	11784-1955
Country	:	US
Telephone Number	:	631-698-0600
Fax Number	:	631-698-2212

Authorized Official
Title or Position	:	DOCTOR GENERAL PARTNER
Name	:	ANNA SCHWARTZ
Credential	:	MD
Telephone Number	:	631-698-0600

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/21/2022

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