Provider Demographics
NPI:1770863953
Name:HISPANIOLA PEDIATRICS PC
Entity Type:Organization
Organization Name:HISPANIOLA PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-565-2144
Mailing Address - Street 1:4048 JUNCTION BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2206
Mailing Address - Country:US
Mailing Address - Phone:718-565-2144
Mailing Address - Fax:718-565-2177
Practice Address - Street 1:4048 JUNCTION BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2206
Practice Address - Country:US
Practice Address - Phone:718-565-2144
Practice Address - Fax:718-565-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty