Provider Demographics
NPI:1073699005
Name:BATAVIA PEDIATRICS, PC
Entity Type:Organization
Organization Name:BATAVIA PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHELENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-343-2611
Mailing Address - Street 1:47 BATAVIA CITY CENTRE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-343-2611
Mailing Address - Fax:585-343-3826
Practice Address - Street 1:47 BATAVIA CITY CENTRE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-343-2611
Practice Address - Fax:585-343-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03028622Medicaid