Provider Demographics
NPI:1356190110
Name:PM PEDIATRICS MANAGEMENT GROUP, LLC
Entity type:Organization
Organization Name:PM PEDIATRICS MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR DIR, CREDENTIALS & ENROLLMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:516-207-7851
Mailing Address - Street 1:1 HOLLOW LN STE 301
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-869-0650
Mailing Address - Fax:516-869-0655
Practice Address - Street 1:1 HOLLOW LN STE 301
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1215
Practice Address - Country:US
Practice Address - Phone:516-869-0650
Practice Address - Fax:516-869-0655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PM PEDIATRICS MANAGEMENT GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care