Provider Demographics
NPI:1184998007
Name:TUXEDO PEDIATRICS PLLC
Entity type:Organization
Organization Name:TUXEDO PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-369-3550
Mailing Address - Street 1:257 LAFAYETTE AVE
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4830
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:257 LAFAYETTE AVE
Practice Address - Street 2:SUITE 290
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4830
Practice Address - Country:US
Practice Address - Phone:845-369-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty