Provider Demographics
NPI:1568042109
Name:FLATIRON PEDIATRICS OF PORT PC
Entity Type:Organization
Organization Name:FLATIRON PEDIATRICS OF PORT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-588-3888
Mailing Address - Street 1:14 VANDERVENTER AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3759
Mailing Address - Country:US
Mailing Address - Phone:516-588-3888
Mailing Address - Fax:646-524-6043
Practice Address - Street 1:14 VANDERVENTER AVE STE 210
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3759
Practice Address - Country:US
Practice Address - Phone:516-588-3888
Practice Address - Fax:646-524-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1912107681Medicaid