Provider Demographics
NPI:1316275316
Name:CHILD LIFE PEDIATRICS, PC
Entity type:Organization
Organization Name:CHILD LIFE PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CADET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-338-5437
Mailing Address - Street 1:346 WESTBURY AVE
Mailing Address - Street 2:LOWER LEVEL, SUITE 11
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1654
Mailing Address - Country:US
Mailing Address - Phone:516-338-5437
Mailing Address - Fax:516-867-3083
Practice Address - Street 1:975 WOODOAK DR
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-5023
Practice Address - Country:US
Practice Address - Phone:516-459-3700
Practice Address - Fax:516-867-3083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty