1770863953 NPI number — HISPANIOLA PEDIATRICS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770863953 NPI number — HISPANIOLA PEDIATRICS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HISPANIOLA PEDIATRICS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770863953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4048 JUNCTION BLVD
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11368-2206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-565-2144
Provider Business Mailing Address Fax Number:
718-565-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4048 JUNCTION BLVD
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11368-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-565-2144
Provider Business Practice Location Address Fax Number:
718-565-2177
Provider Enumeration Date:
08/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MENDEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
MANUEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-565-2144

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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