Provider Demographics
NPI:1609169812
Name:ABC PEDIATRICS & MEDICAL PC
Entity Type:Organization
Organization Name:ABC PEDIATRICS & MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-769-3667
Mailing Address - Street 1:135 OCEANA DRIVE
Mailing Address - Street 2:PH2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:347-742-0260
Mailing Address - Fax:
Practice Address - Street 1:2520 OCEAN AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229
Practice Address - Country:US
Practice Address - Phone:718-769-3667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230201208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02522636Medicaid