Provider Demographics
NPI:1245643501
Name:ELLINWOOD PEDIATRICS PLLC
Entity type:Organization
Organization Name:ELLINWOOD PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY-ANN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:IRISH-BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-725-2773
Mailing Address - Street 1:600 FRENCH RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1037
Mailing Address - Country:US
Mailing Address - Phone:315-725-2773
Mailing Address - Fax:315-316-0501
Practice Address - Street 1:600 FRENCH RD STE 3
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1037
Practice Address - Country:US
Practice Address - Phone:315-725-2773
Practice Address - Fax:315-316-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172945208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty