Provider Demographics
NPI:1760845424
Name:SV PEDIATRICS
Entity Type:Organization
Organization Name:SV PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIEDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-758-6565
Mailing Address - Street 1:155 E WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1423
Mailing Address - Country:US
Mailing Address - Phone:631-758-6565
Mailing Address - Fax:631-758-6568
Practice Address - Street 1:155 E WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1423
Practice Address - Country:US
Practice Address - Phone:631-758-6565
Practice Address - Fax:631-758-6568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382507363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty