Provider Demographics
NPI:1457673527
Name:CHILDREN OF ZION PEDIATRICS
Entity Type:Organization
Organization Name:CHILDREN OF ZION PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAIYE
Authorized Official - Middle Name:OLUBUNMI
Authorized Official - Last Name:APOESO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-665-3387
Mailing Address - Street 1:PO BOX 1225
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-9225
Mailing Address - Country:US
Mailing Address - Phone:718-665-3387
Mailing Address - Fax:718-665-3388
Practice Address - Street 1:225 E 149TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5524
Practice Address - Country:US
Practice Address - Phone:718-665-3387
Practice Address - Fax:718-665-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02149599Medicaid