Provider Demographics
NPI:1275704108
Name:PEDIATRIC STATION PC
Entity Type:Organization
Organization Name:PEDIATRIC STATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASSIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KYRIAKAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-329-2275
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-0518
Mailing Address - Country:US
Mailing Address - Phone:718-329-2275
Mailing Address - Fax:718-329-2276
Practice Address - Street 1:3050 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1306
Practice Address - Country:US
Practice Address - Phone:718-329-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380500261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care