Provider Demographics
NPI:1104987718
Name:THE HERBERT KANIA PEDIATRIC GROUP
Entity type:Organization
Organization Name:THE HERBERT KANIA PEDIATRIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-986-2058
Mailing Address - Street 1:10 RONALD REAGAN BOUVELARD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990
Mailing Address - Country:US
Mailing Address - Phone:845-986-2058
Mailing Address - Fax:
Practice Address - Street 1:10 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4104
Practice Address - Country:US
Practice Address - Phone:845-986-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty