Provider Demographics
NPI:1043685787
Name:TRIBORO PEDIATRICS PC
Entity Type:Organization
Organization Name:TRIBORO PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-507-5800
Mailing Address - Street 1:3540 82ND ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-5105
Mailing Address - Country:US
Mailing Address - Phone:718-507-5800
Mailing Address - Fax:718-507-1017
Practice Address - Street 1:3540 82ND ST
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-5105
Practice Address - Country:US
Practice Address - Phone:718-507-5800
Practice Address - Fax:718-507-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty