MEDICARE: NORTH BALDWIN PEDIATRICS, P.C

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	261QP2300X	Primary Care Clinic/Center	215758	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	:	1104817295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BALDWIN PEDIATRICS, P.C

Provider Business Mailing Address
First Line	:	PO BOX 440
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-0440
Country	:	US
Telephone Number	:	516-771-4582
Fax Number	:	516-771-4583

Provider Business Practice Location Address
First Line	:	2010 GRAND AVE
Second Line	:
City	:	NORTH BALDWIN
State	:	NY
Zip	:	11510-2811
Country	:	US
Telephone Number	:	516-771-4582
Fax Number	:	516-771-4583

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTA DINORA CANALES
Credential	:	MD
Telephone Number	:	516-771-4582

Provider Enumeration Date	:	10/29/2005
Last Update Date	:	02/20/2015

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