Provider Demographics
NPI:1407092257
Name:NEIGHBORHOOD PEDIATRICS OF SI PC
Entity Type:Organization
Organization Name:NEIGHBORHOOD PEDIATRICS OF SI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHVAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-351-1949
Mailing Address - Street 1:3090 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1937
Mailing Address - Country:US
Mailing Address - Phone:718-351-1949
Mailing Address - Fax:718-351-2569
Practice Address - Street 1:3090 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-1937
Practice Address - Country:US
Practice Address - Phone:718-351-1949
Practice Address - Fax:718-351-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129555Medicaid