Provider Demographics
NPI:1306353479
Name:FOUR SEASONS PEDIATRICS, LLC
Entity type:Organization
Organization Name:FOUR SEASONS PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-383-2425
Mailing Address - Street 1:30 HENDRIK HUDSON WAY
Mailing Address - Street 2:
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2672
Mailing Address - Country:US
Mailing Address - Phone:518-383-2425
Mailing Address - Fax:518-383-3255
Practice Address - Street 1:532 MOE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3822
Practice Address - Country:US
Practice Address - Phone:518-383-2425
Practice Address - Fax:518-383-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty