Provider Demographics
NPI:1700474897
Name:NY PEDIATRIC PULMONARY & SLEEP MEDICINE PLLC
Entity type:Organization
Organization Name:NY PEDIATRIC PULMONARY & SLEEP MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-495-1962
Mailing Address - Street 1:465 BLUE POINT RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1839
Mailing Address - Country:US
Mailing Address - Phone:631-495-1962
Mailing Address - Fax:631-615-1043
Practice Address - Street 1:465 BLUE POINT RD
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-1839
Practice Address - Country:US
Practice Address - Phone:631-495-1962
Practice Address - Fax:631-615-1043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
No2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Multi-Specialty