Provider Demographics
NPI:1922282300
Name:HEALTHY KIDS PEDIATRICS PLLC
Entity Type:Organization
Organization Name:HEALTHY KIDS PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN OFFICE MANGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SELTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-944-8555
Mailing Address - Street 1:211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3240
Mailing Address - Country:US
Mailing Address - Phone:516-944-8555
Mailing Address - Fax:516-944-0387
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050
Practice Address - Country:US
Practice Address - Phone:516-944-8555
Practice Address - Fax:516-944-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538129895Medicaid
NY1710921622Medicaid
NY1093776676Medicaid