Provider Demographics
NPI:1225330962
Name:SUNNYSIDE PEDIATRIC ENDOCRINOLOGY, PC
Entity Type:Organization
Organization Name:SUNNYSIDE PEDIATRIC ENDOCRINOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-707-3434
Mailing Address - Street 1:4701 QUEENS BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-1600
Mailing Address - Country:US
Mailing Address - Phone:718-707-3434
Mailing Address - Fax:718-707-3435
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:STE 302
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1600
Practice Address - Country:US
Practice Address - Phone:718-707-3434
Practice Address - Fax:718-707-3435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2364782080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty