Provider Demographics
NPI:1598908550
Name:FLUSHING PEDIATRIC MEDICINE
Entity Type:Organization
Organization Name:FLUSHING PEDIATRIC MEDICINE
Other - Org Name:FLUSHING PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAMUT
Authorized Official - Middle Name:YASAR
Authorized Official - Last Name:CELIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-762-6964
Mailing Address - Street 1:16101 LABURNUM AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3622
Mailing Address - Country:US
Mailing Address - Phone:718-762-6964
Mailing Address - Fax:718-746-0105
Practice Address - Street 1:13848 ELDER AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4066
Practice Address - Country:US
Practice Address - Phone:718-762-6964
Practice Address - Fax:718-746-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235607208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty