Provider Demographics
NPI:1275984130
Name:EINSTEIN PEDIATRICS PLLC
Entity Type:Organization
Organization Name:EINSTEIN PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-716-1854
Mailing Address - Street 1:2235 CEDAR LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5202
Mailing Address - Country:US
Mailing Address - Phone:917-716-1854
Mailing Address - Fax:703-344-7309
Practice Address - Street 1:2235 CEDAR LN
Practice Address - Street 2:SUITE 302
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5202
Practice Address - Country:US
Practice Address - Phone:917-716-1854
Practice Address - Fax:703-344-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty