Provider Demographics
NPI:1497026793
Name:PRINCETON PEDIATRICS
Entity Type:Organization
Organization Name:PRINCETON PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:YANSMITH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-290-3344
Mailing Address - Street 1:6001 SILVER STAR ROAD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808
Mailing Address - Country:US
Mailing Address - Phone:407-290-3344
Mailing Address - Fax:407-290-9941
Practice Address - Street 1:6001 SILVER STAR ROAD
Practice Address - Street 2:SUITE 1A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808
Practice Address - Country:US
Practice Address - Phone:407-290-3344
Practice Address - Fax:407-290-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
FL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052795500Medicaid
FL804240OtherBLUE CROSS BLUE SHEILD