Provider Demographics
NPI:1407813058
Name:FORESTREAM PEDIATRICS, LLP
Entity Type:Organization
Organization Name:FORESTREAM PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-668-5331
Mailing Address - Street 1:4711 TRANSIT RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4888
Mailing Address - Country:US
Mailing Address - Phone:716-668-5331
Mailing Address - Fax:716-668-5370
Practice Address - Street 1:4711 TRANSIT RD
Practice Address - Street 2:SUITE1
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4888
Practice Address - Country:US
Practice Address - Phone:716-668-5331
Practice Address - Fax:716-668-5370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02366498Medicaid
NYAA1483Medicare PIN