Provider Demographics
NPI:1760077259
Name:VERMENTON MOLINA PEDIATRICS PC
Entity Type:Organization
Organization Name:VERMENTON MOLINA PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:VERMENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:929-385-4299
Mailing Address - Street 1:1109 ADEE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5117
Mailing Address - Country:US
Mailing Address - Phone:929-385-4299
Mailing Address - Fax:
Practice Address - Street 1:1055 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2306
Practice Address - Country:US
Practice Address - Phone:929-385-4299
Practice Address - Fax:646-395-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-05
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty