Provider Demographics
NPI:1477131183
Name:ISLAND PEDIATRICS LLC
Entity Type:Organization
Organization Name:ISLAND PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSY
Authorized Official - Middle Name:
Authorized Official - Last Name:YARGER-WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:340-719-7007
Mailing Address - Street 1:5030 ANCHOR WAY STE 6
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4692
Mailing Address - Country:US
Mailing Address - Phone:340-719-7007
Mailing Address - Fax:
Practice Address - Street 1:5030 ANCHOR WAY STE 6
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4692
Practice Address - Country:US
Practice Address - Phone:340-719-7007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty