MEDICARE: MILLENNIUM 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	2080A0000X	Pediatric Adolescent Medicine Physician

General Provider Information

NPI Number	:	1164922936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLENNIUM PEDIATRICS PC

Provider Business Mailing Address
First Line	:	5322 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3910
Country	:	US
Telephone Number	:	718-241-1488
Fax Number	:

Provider Business Practice Location Address
First Line	:	5322 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3910
Country	:	US
Telephone Number	:	718-241-1488
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ASSISTANT TO RCM DORECTOR
Name	:	ARDILYN BUESA
Credential	:
Telephone Number	:	212-257-2424

Provider Enumeration Date	:	02/17/2018
Last Update Date	:	03/07/2025

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