Provider Demographics
NPI:1114361482
Name:COMMUNITY PEDIATRICIAN, PLLC
Entity Type:Organization
Organization Name:COMMUNITY PEDIATRICIAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:ANCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARBULESCU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-205-6160
Mailing Address - Street 1:5314 ROOSEVELT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4239
Mailing Address - Country:US
Mailing Address - Phone:718-205-6160
Mailing Address - Fax:718-205-6180
Practice Address - Street 1:5314 ROOSEVELT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4239
Practice Address - Country:US
Practice Address - Phone:718-205-6160
Practice Address - Fax:718-205-6180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242088208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty