Provider Demographics
NPI:1326058199
Name:MAIN STREET PEDIATRICS PC
Entity Type:Organization
Organization Name:MAIN STREET PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEEMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAUDHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-677-8575
Mailing Address - Street 1:33 GILBERT ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12816-2644
Mailing Address - Country:US
Mailing Address - Phone:518-677-8575
Mailing Address - Fax:518-677-2580
Practice Address - Street 1:33 GILBERT ST STE 3
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2644
Practice Address - Country:US
Practice Address - Phone:518-677-8575
Practice Address - Fax:518-677-2580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty