Provider Demographics
NPI:1205804770
Name:TLC PEDIATRICS
Entity type:Organization
Organization Name:TLC PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PARVANEH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOROJENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-483-5852
Mailing Address - Street 1:1 WEBSTER AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1361
Mailing Address - Country:US
Mailing Address - Phone:845-483-5852
Mailing Address - Fax:845-483-5413
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-483-5852
Practice Address - Fax:845-483-5413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15509612080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty