Provider Demographics
NPI:1447674981
Name:TRIBECA PEDIATRICS, PC
Entity type:Organization
Organization Name:TRIBECA PEDIATRICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNYPACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-226-7666
Mailing Address - Street 1:11 PARK PL
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2801
Mailing Address - Country:US
Mailing Address - Phone:212-226-7666
Mailing Address - Fax:
Practice Address - Street 1:2920 SUNSET BLVD
Practice Address - Street 2:TRIBECA PEDIATRICS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026
Practice Address - Country:US
Practice Address - Phone:212-226-7666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC127654208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty