Provider Demographics
NPI:1033308697
Name:PM PEDIATRICS OF CORONA
Entity Type:Organization
Organization Name:PM PEDIATRICS OF CORONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:PASCALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-677-5437
Mailing Address - Street 1:10211 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10211 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2331
Practice Address - Country:US
Practice Address - Phone:718-458-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, BasicGroup - Single Specialty