Provider Demographics
NPI:1518979327
Name:PARK RIDGE PEDIATRICS PC
Entity Type:Organization
Organization Name:PARK RIDGE PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROMA
Authorized Official - Last Name:HRYCELAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-692-6628
Mailing Address - Street 1:101 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4200
Mailing Address - Country:US
Mailing Address - Phone:847-692-6628
Mailing Address - Fax:847-692-6891
Practice Address - Street 1:101 S WASHINGTON AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4200
Practice Address - Country:US
Practice Address - Phone:847-692-6628
Practice Address - Fax:847-692-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty