Provider Demographics
NPI:1184817389
Name:SCHENECTADY PEDIATRICS
Entity Type:Organization
Organization Name:SCHENECTADY PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAUNAIS
Authorized Official - Suffix:
Authorized Official - Credentials:ASST
Authorized Official - Phone:518-372-5370
Mailing Address - Street 1:1726 CAMPBELL AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306
Mailing Address - Country:US
Mailing Address - Phone:518-372-5370
Mailing Address - Fax:518-372-3472
Practice Address - Street 1:1726 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-5014
Practice Address - Country:US
Practice Address - Phone:518-372-5370
Practice Address - Fax:518-372-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1331021174400000X
NY1383591174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00561495Medicaid