Provider Demographics
NPI:1811014483
Name:PEDIATRICS 2000AT 207 STREET PLLC
Entity Type:Organization
Organization Name:PEDIATRICS 2000AT 207 STREET PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAPIA MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-544-7777
Mailing Address - Street 1:515 W 207TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2645
Mailing Address - Country:US
Mailing Address - Phone:212-544-7777
Mailing Address - Fax:212-544-9660
Practice Address - Street 1:515 W 207TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2645
Practice Address - Country:US
Practice Address - Phone:212-544-7777
Practice Address - Fax:212-544-9660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1760586457OtherNPI
NY1346352408OtherNPI
NY1194828459OtherNPI
NY1326141698OtherNPI
NY13463520408OtherNPI
NY1578666061OtherNPI
NY1225131592OtherNPI
NY1790779064OtherNPI