Provider Demographics
NPI:1215205893
Name:IN TOWN PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:IN TOWN PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:ERIKA
Authorized Official - Last Name:GAZZOLA-KRAENZLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-967-9000
Mailing Address - Street 1:150 PURCHASE ST
Mailing Address - Street 2:SUITE 8A
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2141
Mailing Address - Country:US
Mailing Address - Phone:914-967-9000
Mailing Address - Fax:914-967-9007
Practice Address - Street 1:150 PURCHASE ST
Practice Address - Street 2:SUITE 8A
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2141
Practice Address - Country:US
Practice Address - Phone:914-967-9000
Practice Address - Fax:914-967-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215407261QP2300X
CT040193261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02159204Medicaid