Provider Demographics
NPI:1700657806
Name:PEDIATRICS ON-THE-GO
Entity Type:Organization
Organization Name:PEDIATRICS ON-THE-GO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GASTON
Authorized Official - Middle Name:
Authorized Official - Last Name:OFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-838-2727
Mailing Address - Street 1:2820 NE 214TH ST STE 801
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1269
Mailing Address - Country:US
Mailing Address - Phone:786-838-2727
Mailing Address - Fax:
Practice Address - Street 1:2820 NE 214TH ST STE 801
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-1269
Practice Address - Country:US
Practice Address - Phone:786-838-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty