Provider Demographics
NPI:1609328202
Name:ALL STAR PEDIATRICS PLLC
Entity Type:Organization
Organization Name:ALL STAR PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AZZA
Authorized Official - Middle Name:ABDEL-HAMID
Authorized Official - Last Name:ABO-DEEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-737-4222
Mailing Address - Street 1:2 STOWE RD STE 11
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2582
Mailing Address - Country:US
Mailing Address - Phone:914-737-4222
Mailing Address - Fax:
Practice Address - Street 1:2 STOWE RD STE 11
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2582
Practice Address - Country:US
Practice Address - Phone:914-737-4222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02817105Medicaid