Provider Demographics
NPI:1396006805
Name:THE CHILDREN'S MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:THE CHILDREN'S MEDICAL GROUP PLLC
Other - Org Name:THE CHILDREN'S MEDICAL GROUP PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-452-1700
Mailing Address - Street 1:301 MANCHESTER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2587
Mailing Address - Country:US
Mailing Address - Phone:845-452-1700
Mailing Address - Fax:845-452-1752
Practice Address - Street 1:5 HOOK RD
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1145
Practice Address - Country:US
Practice Address - Phone:845-452-1700
Practice Address - Fax:845-452-1752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty