Provider Demographics
NPI:1760734040
Name:P & P PEDIATRIC, PC
Entity Type:Organization
Organization Name:P & P PEDIATRIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIJAYKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-753-4564
Mailing Address - Street 1:8810 175TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-5554
Mailing Address - Country:US
Mailing Address - Phone:718-753-4564
Mailing Address - Fax:
Practice Address - Street 1:88-10 175TH STREET
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5554
Practice Address - Country:US
Practice Address - Phone:718-753-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217986208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty