MEDICARE: NEIGHBORHOOD PEDIATRICS OF SI 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	214867	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	:	1407092257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD PEDIATRICS OF SI PC

Provider Business Mailing Address
First Line	:	3090 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1937
Country	:	US
Telephone Number	:	718-351-1949
Fax Number	:	718-351-2569

Provider Business Practice Location Address
First Line	:	3090 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1937
Country	:	US
Telephone Number	:	718-351-1949
Fax Number	:	718-351-2569

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. INNA KHVAL
Credential	:	M.D.
Telephone Number	:	718-351-1949

Provider Enumeration Date	:	12/29/2008
Last Update Date	:	12/29/2008

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