Provider Demographics
NPI:1629713771
Name:202 PEDIATRICS PLLC
Entity Type:Organization
Organization Name:202 PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:UGOLINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-517-5333
Mailing Address - Street 1:61 NEW MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10927-1885
Mailing Address - Country:US
Mailing Address - Phone:845-517-5333
Mailing Address - Fax:845-517-5331
Practice Address - Street 1:61 NEW MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1885
Practice Address - Country:US
Practice Address - Phone:845-517-5333
Practice Address - Fax:845-517-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care