Provider Demographics
NPI:1700373537
Name:NORTHSIDE PEDIATRICS
Entity Type:Organization
Organization Name:NORTHSIDE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:PATSY
Authorized Official - Last Name:BOBDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-966-1900
Mailing Address - Street 1:970 N BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1310
Mailing Address - Country:US
Mailing Address - Phone:914-966-1900
Mailing Address - Fax:914-966-0028
Practice Address - Street 1:970 N BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1310
Practice Address - Country:US
Practice Address - Phone:914-966-1900
Practice Address - Fax:914-966-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217852208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty