Basic Information
| Provider Information | |||||||||
| NPI: | 1356000160 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIBECA PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 PARK PL STE 1200 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100072823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122267666 | ||||||||
| FaxNumber: | 9298889562 | ||||||||
| Practice Location | |||||||||
| Address1: | 74 WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | HOBOKEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122267666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2021 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | DIAZ | ||||||||
| AuthorizedOfficialFirstName: | SHANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2122267666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.