| Island Kids Pediatrics, P.c. | |
|
2066 Richmond Avenue 1st Floor Staten Island NY 10314-3916 | |
| (718) 982-9001 | |
| (718) 982-9008 |
| Full Name | Island Kids Pediatrics, P.c. |
|---|---|
| Speciality | Pediatrics - Adolescent Medicine |
| Location | 2066 Richmond Avenue, Staten Island, New York |
| Authorized Official Name and Position | Deniz Cereb (PRESIDENT) |
| Authorized Official Contact | 7189829001 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Island Kids Pediatrics, P.c. 2066 Richmond Avenue 1st Floor Staten Island NY 10314-3916 Ph: (718) 982-9001 | Island Kids Pediatrics, P.c. 2066 Richmond Avenue 1st Floor Staten Island NY 10314-3916 Ph: (718) 982-9001 |
| NPI Number | 1487792024 |
|---|---|
| Provider Enumeration Date | 02/04/2007 |
| Last Update Date | 08/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487792024 | NPI | - | NPPES |
| 01717335 | Medicaid | NY | |
| 03120101 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 200270 (New York) | Secondary |
| 2080A0000X | Pediatrics - Adolescent Medicine | 200270 (New York) | Primary |
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