Provider Demographics
NPI: | 1467454967 |
---|---|
Name: | BOSTON CHILDREN'S HEALTH PHYSICIANS, LLP |
Entity Type: | Organization |
Organization Name: | BOSTON CHILDREN'S HEALTH PHYSICIANS, LLP |
Other - Org Name: | CHILDREN'S & WOMENS PHYSICIANS OF WESTCHESTER, LLP |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | CHIEF OPERATING OFFICER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SHAW |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 914-594-2392 |
Mailing Address - Street 1: | 40 SUNSHINE COTTAGE RD OFC 1N-D06 |
Mailing Address - Street 2: | |
Mailing Address - City: | VALHALLA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10595-1524 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 914-594-2100 |
Mailing Address - Fax: | 914-593-1790 |
Practice Address - Street 1: | 19 SKYLINE DR OFC 1N-D06 |
Practice Address - Street 2: | |
Practice Address - City: | HAWTHORNE |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10532 |
Practice Address - Country: | US |
Practice Address - Phone: | 914-594-2100 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-08-15 |
Last Update Date: | 2021-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 208000000X, 2080A0000X, 2080N0001X, 2080P0006X, 2080P0201X, 2080P0202X, 2080P0203X, 2080P0205X, 2080P0206X, 2080P0207X, 2080P0214X, 2084P0804X, 2084P0804X, 208G00000X | |
252Y00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | Group - Multi-Specialty |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 0198498 | Medicaid | |
CT | 003128437 | Medicaid | |
NY | 02511604 | Medicaid | |
NY | 02511604 | Medicaid | |
NY | WEA202 | Medicare PIN |