Basic Information
| Provider Information | |||||||||
| NPI: | 1417481706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIBECA PEDIATRICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 PARK PL | ||||||||
| Address2: | SUITE 1200 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100072801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122267666 | ||||||||
| FaxNumber: | 2122027988 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100070029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122267666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | SHEA | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2122267666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.