Provider Demographics
NPI:1073270484
Name:PM PEDIATRICS OF NEW ENGLAND
Entity Type:Organization
Organization Name:PM PEDIATRICS OF NEW ENGLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIR. CRED ENROLLMENT & PROV REL
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:516-207-7851
Mailing Address - Street 1:1 HOLLOW LN STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-207-7851
Mailing Address - Fax:516-207-7851
Practice Address - Street 1:97 PEARL STREET
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:NY
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-848-5437
Practice Address - Fax:781-848-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty