Provider Demographics
NPI:1255597373
Name:ABC PEDIATRICS
Entity type:Organization
Organization Name:ABC PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAYORAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-766-4094
Mailing Address - Street 1:176 N VILLAGE AVE
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3800
Mailing Address - Country:US
Mailing Address - Phone:516-766-4094
Mailing Address - Fax:516-766-4092
Practice Address - Street 1:176 N VILLAGE AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-766-4094
Practice Address - Fax:516-766-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2205822080T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical ToxicologyGroup - Single Specialty