Provider Demographics
NPI:1831379395
Name:BEACH PEDIATRICS PLLC
Entity type:Organization
Organization Name:BEACH PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PISCITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-897-5000
Mailing Address - Street 1:312 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1510
Mailing Address - Country:US
Mailing Address - Phone:516-897-5000
Mailing Address - Fax:
Practice Address - Street 1:312 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1510
Practice Address - Country:US
Practice Address - Phone:516-897-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1529262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty