Organization Active NPI

Advanced Pediatrics, PC

  • Pediatrics Physician
  • Elmhurst, NY
National Provider Identifier
1083815385
Registry record updated Feb 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
211204 Issued in NY
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, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2012

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
01860195MedicaidNY
01922430MedicaidNY

National Provider Directory

National Provider Directory

Locations

9436 59th Ave
Ste C4
Elmhurst, NY 11373
Phone (718) 271-2600

Interoperability endpoints

  • FHIR API: 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.

Verify at the official NPI Registry.