Provider Demographics
NPI:1932155314
Name:NASSAU BAY PEDIATRICS PA
Entity Type:Organization
Organization Name:NASSAU BAY PEDIATRICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJAMMA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-212-2400
Mailing Address - Street 1:150 E MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4301
Mailing Address - Country:US
Mailing Address - Phone:281-212-2400
Mailing Address - Fax:281-212-2499
Practice Address - Street 1:150 E MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4301
Practice Address - Country:US
Practice Address - Phone:281-212-2400
Practice Address - Fax:281-212-2499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155278802OtherTHSTEPS
TX155278801Medicaid