Provider Demographics
NPI:1033248562
Name:HAVERSTRAW PEDIATRICS
Entity Type:Organization
Organization Name:HAVERSTRAW PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VIDHU
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-429-3382
Mailing Address - Street 1:48 NEW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1812
Mailing Address - Country:US
Mailing Address - Phone:845-429-3382
Mailing Address - Fax:845-429-2057
Practice Address - Street 1:48 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1812
Practice Address - Country:US
Practice Address - Phone:845-429-3382
Practice Address - Fax:845-429-2057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2273542080A0000X
NY1090772080A0000X
NY1290962080A0000X
NY1364342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty