METRO MEDICAL PRACTICE PC NPI 1063098945

NPI Information

  • NPI: 1063098945
  • Provider Name: METRO MEDICAL PRACTICE PC
  • Classification: Pediatrics - 2080A0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Organization
  • Address: 11607 METROPOLITAN AVE STE 102
    KEW GARDENS, NY
    ZIP 11418
  • Phone: (718) 850-9225

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NPI Details

METRO MEDICAL PRACTICE PC is an adolescent medicine pediatrics in Kew Gardens, NY. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. METRO MEDICAL PRACTICE PC NPI is 1063098945. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

11607 METROPOLITAN AVE STE 102
KEW GARDENS, NY
ZIP 11418-018
Phone: (718) 850-9225
Fax: (718) 850-9226

The provider's authorized official is Nancy Wallach .
The authorized official title is Owner and has the following contact phone number (718) 850-9225.

The enumeration date for this NPI number is 3/22/2021 and was last updated on 5/29/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080A0000XPediatricsAdolescent MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
102244920MEDICAIDNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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