Provider Demographics
NPI:1720493513
Name:FAMILY PEDIATRICS CARE
Entity Type:Organization
Organization Name:FAMILY PEDIATRICS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:NADGEFFRENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-503-7855
Mailing Address - Street 1:13333 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13333 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2117
Practice Address - Country:US
Practice Address - Phone:516-503-7855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3180061251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health