Provider Demographics
NPI:1679974760
Name:PREMIER PEDIATRICS CARE PC
Entity Type:Organization
Organization Name:PREMIER PEDIATRICS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:ELEANOR
Authorized Official - Last Name:DUVIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:5165-654-2056
Mailing Address - Street 1:72 FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3651
Mailing Address - Country:US
Mailing Address - Phone:516-564-2056
Mailing Address - Fax:516-564-2055
Practice Address - Street 1:72 FULTON AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3651
Practice Address - Country:US
Practice Address - Phone:516-564-2056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty