Provider Demographics
NPI:1033162607
Name:PEDIATRIC ASSOCIATES PSN LLC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES PSN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-965-7332
Mailing Address - Street 1:4620 N ST RD 7
Mailing Address - Street 2:SUITE 316
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-967-6400
Mailing Address - Fax:954-965-7339
Practice Address - Street 1:4620 N ST RD 7
Practice Address - Street 2:SUITE 316
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-967-6400
Practice Address - Fax:954-965-7339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty