Provider Demographics
NPI:1164579124
Name:SCARSDALE PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:SCARSDALE PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-725-0800
Mailing Address - Street 1:2 OVERHILL RD
Mailing Address - Street 2:SUITE220
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5323
Mailing Address - Country:US
Mailing Address - Phone:914-725-0800
Mailing Address - Fax:914-722-4501
Practice Address - Street 1:2 OVERHILL RD
Practice Address - Street 2:SUITE220
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5323
Practice Address - Country:US
Practice Address - Phone:914-725-0800
Practice Address - Fax:914-722-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159862208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1020828Medicaid
NY1020828Medicaid