Basic Information
| Provider Information | |||||||||
| NPI: | 1982913927 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ELIZABETH SETON PEDIATRIC CENTER | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | ELIZABETH SETON CHILDREN'S CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 CORPORATE BLVD S | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107016862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142946300 | ||||||||
| FaxNumber: | 9142946181 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 CORPORATE BLVD S | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142946300 | ||||||||
| FaxNumber: | 9142946181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2010 | ||||||||
| LastUpdateDate: | 04/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | PERRUCCIO | ||||||||
| AuthorizedOfficialFirstName: | M. CARLA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9142946128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336I0012X | 030218 | NY | Y | Suppliers | Pharmacy | Institutional Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 04964196 | 05 | NY | MEDICAID | 030218 | 01 | NY | PHARMACY CERTIFICATION | OTHER | 5800811 | 01 | NCPDP | OTHER | FN2320353 | 01 | NY | CONTROLLED SUBSTANCES DEA CERTIFICATION | OTHER |