Provider Demographics
NPI:1952971715
Name:TIER PEDIATRICS LLC
Entity Type:Organization
Organization Name:TIER PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BATTLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-624-2928
Mailing Address - Street 1:256 HARRY L DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1423
Mailing Address - Country:US
Mailing Address - Phone:607-777-9475
Mailing Address - Fax:
Practice Address - Street 1:256 HARRY L DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1423
Practice Address - Country:US
Practice Address - Phone:607-777-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01150325Medicaid