Provider Demographics
NPI:1700189149
Name:RIDGEWOOD PEDIATRICS PC
Entity Type:Organization
Organization Name:RIDGEWOOD PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:GINEBRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-484-8488
Mailing Address - Street 1:186 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4438
Mailing Address - Country:US
Mailing Address - Phone:718-484-8488
Mailing Address - Fax:718-484-8488
Practice Address - Street 1:186 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4438
Practice Address - Country:US
Practice Address - Phone:718-484-8488
Practice Address - Fax:718-484-8487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197158208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty