Provider Demographics
NPI:1013003482
Name:DEVELOPMENTAL PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:DEVELOPMENTAL PEDIATRICS, PLLC
Other - Org Name:DEVELOPMENTAL PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-782-7733
Mailing Address - Street 1:7B JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3003
Mailing Address - Country:US
Mailing Address - Phone:518-782-7733
Mailing Address - Fax:518-782-0800
Practice Address - Street 1:7B JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3003
Practice Address - Country:US
Practice Address - Phone:518-782-7733
Practice Address - Fax:518-782-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119952-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty