Provider Demographics
NPI:1831131333
Name:WEST SUBURBAN PEDIATRICS
Entity Type:Organization
Organization Name:WEST SUBURBAN PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOLDSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-431-2360
Mailing Address - Street 1:258 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02481-4964
Mailing Address - Country:US
Mailing Address - Phone:781-431-2360
Mailing Address - Fax:781-431-2366
Practice Address - Street 1:258 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481-4964
Practice Address - Country:US
Practice Address - Phone:781-431-2360
Practice Address - Fax:781-431-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17471OtherBLUE SHIELD GROUP NUMBER
MA686394OtherTUFTS GROUP NUMBER
MA9787429Medicaid