Provider Demographics
NPI:1205232246
Name:GLENDALE PEDIATRICS P.C.
Entity Type:Organization
Organization Name:GLENDALE PEDIATRICS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:APOSTOLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TSOUMPARIOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-821-4200
Mailing Address - Street 1:7309 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7418
Mailing Address - Country:US
Mailing Address - Phone:718-821-4200
Mailing Address - Fax:718-821-5600
Practice Address - Street 1:7309 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7418
Practice Address - Country:US
Practice Address - Phone:718-821-4200
Practice Address - Fax:718-821-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty