Provider Demographics
NPI:1447027420
Name:PEDIATRIC NOW MEDICAL CARE, PLLC
Entity type:Organization
Organization Name:PEDIATRIC NOW MEDICAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVANTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-622-2176
Mailing Address - Street 1:6746 WARD RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4556
Mailing Address - Country:US
Mailing Address - Phone:716-622-2176
Mailing Address - Fax:
Practice Address - Street 1:5100 W TAFT RD STE B
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:716-622-2176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty