Provider Demographics
NPI:1689825515
Name:HAPPY & HEALTHY PEDIATRICS PC
Entity Type:Organization
Organization Name:HAPPY & HEALTHY PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-216-5910
Mailing Address - Street 1:PO BOX 1720
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-0902
Mailing Address - Country:US
Mailing Address - Phone:516-216-5910
Mailing Address - Fax:516-216-5907
Practice Address - Street 1:77 JERICHO TPKE
Practice Address - Street 2:SUITE 175
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2984
Practice Address - Country:US
Practice Address - Phone:516-216-5910
Practice Address - Fax:516-216-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230355261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02909520Medicaid