Provider Demographics
NPI:1093717993
Name:KIDS CARE PEDIATRICS
Entity Type:Organization
Organization Name:KIDS CARE PEDIATRICS
Other - Org Name:DVORKEN, ALONI, LUSTIK & SCHWARTZ MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-698-0600
Mailing Address - Street 1:239 BOYLE RD
Mailing Address - Street 2:STE 7
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1955
Mailing Address - Country:US
Mailing Address - Phone:631-698-0600
Mailing Address - Fax:631-698-2212
Practice Address - Street 1:239 BOYLE RD
Practice Address - Street 2:STE 7
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-1955
Practice Address - Country:US
Practice Address - Phone:631-698-0600
Practice Address - Fax:631-698-2212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty