Provider Demographics
NPI:1750427241
Name:PEDIATRIC HEAD AND NECK ASSOCIATES, PC
Entity type:Organization
Organization Name:PEDIATRIC HEAD AND NECK ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DYLESKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-979-4200
Mailing Address - Street 1:310 E 14TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4201
Mailing Address - Country:US
Mailing Address - Phone:212-979-4200
Mailing Address - Fax:212-979-4510
Practice Address - Street 1:310 E 14TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4201
Practice Address - Country:US
Practice Address - Phone:212-979-4200
Practice Address - Fax:212-979-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric OtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7M7681Medicare ID - Type Unspecified