Active NPI
Advanced Pediatrics, PC
- Pediatrics Physician
- Elmhurst, NY
National Provider Identifier
1083815385
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 211204
- Legal business name
- ADVANCED PEDIATRICS, PC
- Practice address
- 9436 59TH Ave
Suite C4
Elmhurst, NY 11373-5151 - Phone
- (718) 271-2600
- Fax
- (718) 271-2766
- NPI assigned
- May 31, 2007
- Last updated
- Feb 23, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Wilfredo Lao, M.D.
- Title
- Partner
- Phone
- (718) 271-2600
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 211204 | NY | Primary |
Addresses
Primary practice location
9436 59TH Ave
Suite C4
Elmhurst, NY 11373-5151
Mailing address
9436 59TH Ave
Suite C4
Elmhurst, NY 11373-5151
Phone (718) 271-2600
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01860195 | Medicaid | NY | |
| 01922430 | Medicaid | NY |
National Provider Directory
National Provider DirectoryLocations
9436 59th Ave
Ste C4
Elmhurst, NY 11373
Phone (718) 271-2600
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JIAHAA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180569600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1329955200000",
"number": "1083815385",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9436 59TH AVE",
"address_2": "SUITE C4",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113735151",
"telephone_number": "718-271-2600",
"fax_number": "718-271-2766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9436 59TH AVE",
"address_2": "SUITE C4",
"city": "ELMHURST",
"state": "NY",
"postal_code": "113735151",
"telephone_number": "718-271-2600",
"fax_number": "718-271-2766"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED PEDIATRICS, PC",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-31",
"last_updated": "2012-02-23",
"status": "A",
"authorized_official_last_name": "LAO",
"authorized_official_first_name": "WILFREDO",
"authorized_official_title_or_position": "PARTNER",
"authorized_official_telephone_number": "718-271-2600",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "211204",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01860195",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01922430",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Elmhurst, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.