Provider Demographics
NPI:1578615704
Name:NORTHEAST CORNERSTONE PEDIATRICS,PA
Entity Type:Organization
Organization Name:NORTHEAST CORNERSTONE PEDIATRICS,PA
Other - Org Name:NEC PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AKINTOLUWA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AKINJAIYEJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-821-5900
Mailing Address - Street 1:10755 KENWORTHY ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1717
Mailing Address - Country:US
Mailing Address - Phone:915-821-5900
Mailing Address - Fax:915-821-5902
Practice Address - Street 1:10755 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-1717
Practice Address - Country:US
Practice Address - Phone:915-821-5900
Practice Address - Fax:915-821-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9596208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty