Provider Type Icon

PATCHOGUE PEDIATRICS PC NPI 1396178000


NPI Information

NPI: 1396178000
Provider Name: PATCHOGUE PEDIATRICS PC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 33D2066029

Address:
264 SILLS RD
EAST PATCHOGUE, NY
ZIP 11772
Phone: (631) 504-6261
Get Directions

PATCHOGUE PEDIATRICS PC is a pediatrics in East Patchogue, 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. PATCHOGUE PEDIATRICS PC NPI is 1396178000. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

264 SILLS RD
EAST PATCHOGUE, NY
ZIP 11772-804
Phone: (631) 504-6261
Fax: (631) 504-6263

The provider's authorized official is Audrey A Chong-gayle .
The authorized official title is President and has the following contact phone number (631) 504-6261.

The CLIA number assigned to this NPI record is 33D2066029 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2013 and was last updated on 8/16/2013.


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
1208000000XPediatricsYes

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
102022351MEDICAIDNEW 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

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.