Provider Demographics
NPI:1013589365
Name:PURE PEDIATRICS, PC
Entity Type:Organization
Organization Name:PURE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-796-2196
Mailing Address - Street 1:60B MOTT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4811
Mailing Address - Country:US
Mailing Address - Phone:212-796-2196
Mailing Address - Fax:212-796-2195
Practice Address - Street 1:60B MOTT ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4811
Practice Address - Country:US
Practice Address - Phone:212-796-2196
Practice Address - Fax:212-796-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty