Provider Demographics
| NPI: | 1902200041 |
|---|---|
| Name: | WINTHROP FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORPOR |
| Entity Type: | Organization |
| Organization Name: | WINTHROP FACULTY MEDICAL AFFILIATES UNIVERSITY FACULTY PRACTICE CORPOR |
| Other - Org Name: | WINTHROP PEDIATRIC ASSOCIATES |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | CO-PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | MICHAEL |
| Authorized Official - Middle Name: | D |
| Authorized Official - Last Name: | AMMAZZALORSO |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 516-663-8209 |
| Mailing Address - Street 1: | 700 HICKSVILLE RD |
| Mailing Address - Street 2: | SUITE 204 |
| Mailing Address - City: | BETHPAGE |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 11714-3471 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 516-576-5715 |
| Mailing Address - Fax: | 516-576-5801 |
| Practice Address - Street 1: | 222 STATION PLZ N |
| Practice Address - Street 2: | SUITE 611 |
| Practice Address - City: | MINEOLA |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 11501-3800 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 516-663-2532 |
| Practice Address - Fax: | 516-663-8874 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2014-10-17 |
| Last Update Date: | 2014-10-17 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
| No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
| No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
| No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
| No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
| No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
| No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
| No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
| No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
| No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
| No | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Multi-Specialty |
| No | 2080S0012X | Allopathic & Osteopathic Physicians | Pediatrics | Sleep Medicine | Group - Multi-Specialty |
