Provider Demographics
NPI:1124147186
Name:LIFE PEDIATRICS PLLC
Entity type:Organization
Organization Name:LIFE PEDIATRICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-627-8870
Mailing Address - Street 1:146 W 22ND ST
Mailing Address - Street 2:APT 11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2477
Mailing Address - Country:US
Mailing Address - Phone:212-627-8870
Mailing Address - Fax:
Practice Address - Street 1:161 AVENUE OF THE AMERICAS
Practice Address - Street 2:13 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1205
Practice Address - Country:US
Practice Address - Phone:212-627-1222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty