Provider Demographics
NPI:1316304231
Name:PEDIATRIC CARE OF NEW YORK P.C.
Entity type:Organization
Organization Name:PEDIATRIC CARE OF NEW YORK P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FAIZ
Authorized Official - Middle Name:O
Authorized Official - Last Name:ALZOOBAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-432-9355
Mailing Address - Street 1:1932 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3914
Mailing Address - Country:US
Mailing Address - Phone:347-432-9355
Mailing Address - Fax:
Practice Address - Street 1:70 IRONMINE DR
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-1130
Practice Address - Country:US
Practice Address - Phone:347-432-9355
Practice Address - Fax:718-833-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223071-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty