Provider Demographics
NPI:1497078554
Name:JEROME PEDIATRIC P.C
Entity Type:Organization
Organization Name:JEROME PEDIATRIC P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIANCARLO
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-220-1771
Mailing Address - Street 1:2386 JEROME AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6401
Mailing Address - Country:US
Mailing Address - Phone:718-220-1771
Mailing Address - Fax:718-220-1775
Practice Address - Street 1:2386 JEROME AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6401
Practice Address - Country:US
Practice Address - Phone:718-220-1771
Practice Address - Fax:718-220-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233015261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care