Provider Demographics
NPI:1508134578
Name:HICKSVILLE PEDIATRICS PC
Entity Type:Organization
Organization Name:HICKSVILLE PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHROTRA
Authorized Official - Suffix:
Authorized Official - Credentials:M D,
Authorized Official - Phone:516-719-0344
Mailing Address - Street 1:535 S BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5029
Mailing Address - Country:US
Mailing Address - Phone:516-719-0344
Mailing Address - Fax:516-719-0345
Practice Address - Street 1:535 S BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5029
Practice Address - Country:US
Practice Address - Phone:516-719-0344
Practice Address - Fax:516-719-0345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2115972080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty