Provider Demographics
NPI:1497891139
Name:WESTCHESTER PARK PEDIATRICS
Entity Type:Organization
Organization Name:WESTCHESTER PARK PEDIATRICS
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-761-1717
Mailing Address - Street 1:222 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604
Mailing Address - Country:US
Mailing Address - Phone:914-761-1717
Mailing Address - Fax:914-761-1711
Practice Address - Street 1:222 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 202
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604
Practice Address - Country:US
Practice Address - Phone:914-761-1717
Practice Address - Fax:914-761-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1979441208000000X
NY156681208000000X
NY196252208000000X
NY153890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty