Provider Demographics
NPI:1043483449
Name:ISLAND HEIGHTS PEDIATRICS PC
Entity type:Organization
Organization Name:ISLAND HEIGHTS PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGOLETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-238-1000
Mailing Address - Street 1:8014 13 AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3002
Mailing Address - Country:US
Mailing Address - Phone:718-238-1000
Mailing Address - Fax:718-238-1802
Practice Address - Street 1:8014 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3002
Practice Address - Country:US
Practice Address - Phone:718-238-1000
Practice Address - Fax:718-238-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty