Provider Demographics
NPI:1194034322
Name:TOMAHAWK FARM PEDIATRICS
Entity Type:Organization
Organization Name:TOMAHAWK FARM PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ODELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-248-0500
Mailing Address - Street 1:157 TOMAHAWK ST
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-6314
Mailing Address - Country:US
Mailing Address - Phone:914-248-0500
Mailing Address - Fax:914-248-5478
Practice Address - Street 1:157 TOMAHAWK ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-6314
Practice Address - Country:US
Practice Address - Phone:914-248-0500
Practice Address - Fax:914-248-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty