Provider Demographics
NPI:1992024665
Name:PM PEDIATRICS
Entity Type:Organization
Organization Name:PM PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GABINSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-531-6660
Mailing Address - Street 1:2378 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5515
Mailing Address - Country:US
Mailing Address - Phone:718-531-6660
Mailing Address - Fax:718-531-6662
Practice Address - Street 1:2378 RALPH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5515
Practice Address - Country:US
Practice Address - Phone:718-531-6660
Practice Address - Fax:718-531-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203607208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01952405Medicaid