Provider Demographics
NPI:1073997623
Name:GOSHEN PEDIATRICS, PC
Entity Type:Organization
Organization Name:GOSHEN PEDIATRICS, PC
Other - Org Name:CHESTER PEDIATRICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:N
Authorized Official - Last Name:WAPSHARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-291-7059
Mailing Address - Street 1:2002 ROUTE 17M
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924
Mailing Address - Country:US
Mailing Address - Phone:845-291-7059
Mailing Address - Fax:845-291-0905
Practice Address - Street 1:2002 ROUTE 17M
Practice Address - Street 2:SUITE 8
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924
Practice Address - Country:US
Practice Address - Phone:845-291-7059
Practice Address - Fax:845-291-0905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOSHEN PEDIATRICS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-14
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01364167Medicaid
NY01L261OtherBC