Provider Demographics
NPI:1396844973
Name:PEDIATRIC ARTS OF MONROE
Entity Type:Organization
Organization Name:PEDIATRIC ARTS OF MONROE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-782-8608
Mailing Address - Street 1:91 LAKES RD
Mailing Address - Street 2:MONROE MEDICAL ARTS BUILDING
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2613
Mailing Address - Country:US
Mailing Address - Phone:847-782-8608
Mailing Address - Fax:845-782-8516
Practice Address - Street 1:91 LAKES RD
Practice Address - Street 2:MONROE MEDICAL ARTS BUILDING
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2613
Practice Address - Country:US
Practice Address - Phone:847-782-8608
Practice Address - Fax:845-782-8516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID #