FOUR SEASONS PEDIATRICS LLC NPI 1750387817

NPI Information

NPI: 1750387817
Provider Name: FOUR SEASONS PEDIATRICS, LLC
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
532 MOE RD
CLIFTON PARK, NY
ZIP 12065
Phone: (518) 383-2425
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FOUR SEASONS PEDIATRICS, LLC is an adolescent medicine pediatrics in Clifton Park, 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. FOUR SEASONS PEDIATRICS, LLC NPI is 1750387817. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

532 MOE RD
CLIFTON PARK, NY
ZIP 12065-822
Phone: (518) 383-2425
Fax: (518) 383-3255

The provider's authorized official is Harry Sellers Miller .
The authorized official title is Partner and has the following contact phone number (518) 383-2425.

The enumeration date for this NPI number is 6/23/2005 and was last updated on 3/5/2012.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080A0000X	Pediatrics	Adolescent Medicine	182956	NEW YORK	Yes

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
1	00347562	MEDICAID	NEW YORK
2	AA1245	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK
3	G16078	MEDICARE UPIN	NEW YORK
4	DD1244	MEDICARE ID-TYPE UNSPECIFIED
5	01355619	MEDICAID	NEW YORK
6	F41272	MEDICARE UPIN	NEW 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: 5/5/2024

NPI Synchronization or Removal

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