Provider Demographics
NPI:1679116214
Name:JENKS PARK PEDIATRICS, INC.
Entity Type:Organization
Organization Name:JENKS PARK PEDIATRICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATA
Authorized Official - Middle Name:FELICIA
Authorized Official - Last Name:NELKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-339-7046
Mailing Address - Street 1:577 BROAD ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CENTRAL FALLS
Mailing Address - State:RI
Mailing Address - Zip Code:02863-2837
Mailing Address - Country:US
Mailing Address - Phone:401-339-7046
Mailing Address - Fax:
Practice Address - Street 1:577 BROAD ST FL 1
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2837
Practice Address - Country:US
Practice Address - Phone:401-339-7046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty