Provider Demographics
NPI:1427241082
Name:EASTCHESTER PEDIATRIC MEDICAL GRP
Entity type:Organization
Organization Name:EASTCHESTER PEDIATRIC MEDICAL GRP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:R ITA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-337-3960
Mailing Address - Street 1:266 WHITE PLAINS RD
Mailing Address - Street 2:SUITE A3
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-4429
Mailing Address - Country:US
Mailing Address - Phone:914-337-3960
Mailing Address - Fax:914-395-1537
Practice Address - Street 1:266 WHITE PLAINS RD
Practice Address - Street 2:SUITE A3
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-4429
Practice Address - Country:US
Practice Address - Phone:914-337-3960
Practice Address - Fax:914-395-1537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTCHESTER PEDIATRIC MEDICAL GRP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty