Provider Demographics
NPI:1255604583
Name:DELAWARE PEDIATRIC ASSOCIATES
Entity type:Organization
Organization Name:DELAWARE PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDGE
Authorized Official - Last Name:SCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-884-0230
Mailing Address - Street 1:2550 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1721
Mailing Address - Country:US
Mailing Address - Phone:716-884-0230
Mailing Address - Fax:
Practice Address - Street 1:2550 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1721
Practice Address - Country:US
Practice Address - Phone:716-884-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101753208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00652882Medicaid
NY00963722Medicaid
NY01029556Medicaid
NY01398705Medicaid
NY02952789Medicaid
NY03357173Medicaid
NY02161773Medicaid