Provider Demographics
NPI:1538373279
Name:EXECUTIVE PEDIATRICS PC
Entity type:Organization
Organization Name:EXECUTIVE PEDIATRICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRITTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-963-7668
Mailing Address - Street 1:984 N BROADWAY STE 506
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1308
Mailing Address - Country:US
Mailing Address - Phone:914-963-7668
Mailing Address - Fax:
Practice Address - Street 1:984 N BROADWAY STE 506
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:914-963-7668
Practice Address - Fax:914-963-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1003885039OtherNPI
NY1932263696OtherNPI
NY1003885039OtherNPI