Provider Type Icon

I M PEDIATRICS PC NPI 1669456984


NPI Information

NPI: 1669456984
Provider Name: I M PEDIATRICS PC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 33D1004178

Address:
6412 FRESH POND RD
RIDGEWOOD, NY
ZIP 11385
Phone: (718) 497-1565
Get Directions

I M PEDIATRICS PC is a pediatrics in Ridgewood, NY. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. I M PEDIATRICS PC NPI is 1669456984. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6412 FRESH POND RD
RIDGEWOOD, NY
ZIP 11385-331
Phone: (718) 497-1565
Fax: (718) 497-1567

The provider's authorized official is Iwona Katarzyna Mienko .
The authorized official title is President and has the following contact phone number (718) 497-1565.

The CLIA number assigned to this NPI record is 33D1004178 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/30/2005 and was last updated on 2/24/2012.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics217951NEW YORKYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
104341MEDICARE ID-TYPE UNSPECIFIEDNEW YORK
2H30630MEDICARE UPIN
302105622MEDICAIDNEW 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: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.