Provider Demographics
NPI:1063629186
Name:BORO PARK PEDIATRIC ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:BORO PARK PEDIATRIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-438-4400
Mailing Address - Street 1:4406 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2077
Mailing Address - Country:US
Mailing Address - Phone:718-438-4400
Mailing Address - Fax:718-438-4404
Practice Address - Street 1:4406 12TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2077
Practice Address - Country:US
Practice Address - Phone:718-438-4400
Practice Address - Fax:718-438-4404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty