Provider Demographics
NPI:1154759967
Name:PEDIA-CARE PHYSICIANS, PLLC
Entity type:Organization
Organization Name:PEDIA-CARE PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GINDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-376-6425
Mailing Address - Street 1:1636 E 14TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1190
Mailing Address - Country:US
Mailing Address - Phone:718-376-6425
Mailing Address - Fax:718-376-6427
Practice Address - Street 1:1636 E 14TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1190
Practice Address - Country:US
Practice Address - Phone:718-376-6425
Practice Address - Fax:718-376-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149046207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty