Provider Demographics
NPI:1558532796
Name:WAKEFIELD PEDIATRICS,PLLC
Entity Type:Organization
Organization Name:WAKEFIELD PEDIATRICS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-ANSAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-882-2835
Mailing Address - Street 1:4813 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1101
Mailing Address - Country:US
Mailing Address - Phone:718-882-2835
Mailing Address - Fax:718-882-8176
Practice Address - Street 1:4813 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1101
Practice Address - Country:US
Practice Address - Phone:718-882-2835
Practice Address - Fax:718-882-8176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center