Provider Demographics
NPI:1629258033
Name:KIDS FIRST PEDIATRICS, PC
Entity Type:Organization
Organization Name:KIDS FIRST PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-331-7267
Mailing Address - Street 1:815 HALLOCK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1220
Mailing Address - Country:US
Mailing Address - Phone:631-331-7267
Mailing Address - Fax:631-331-7289
Practice Address - Street 1:815 HALLOCK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1220
Practice Address - Country:US
Practice Address - Phone:631-331-7267
Practice Address - Fax:631-331-7289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164113208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty