Boston Pediatrics, PLLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

214716 Issued in NY

Legal business name

BOSTON PEDIATRICS, PLLC

Practice address

1262 Boston Rd
Suite 1
Bronx, NY 10456-3602

Phone

(718) 617-2500

Fax

(718) 617-0500

NPI assigned

Aug 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jorge Luis Cornielle, M.D.

Title

Medical Doctor

Phone

(718) 617-2500

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Boston Road Pediatrics, PC Former legal business name

Tax ID family

Boston Pediatrics PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Boston Pediatrics PLLC

  • Nurse Practitioner
  • Bronx, NY
  • NPI 1043682040
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shannon Patricia More Jarzynka, DNP, CPNP

  • Pediatric Nurse Practitioner
  • Bronx, NY
  • NPI 1730430786
  NPD (past)
• Estefany Yanerys Morillo Tamayo, M.D

  • Pediatrics Physician
  • Bronx, NY
  • NPI 1154725968
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359590400000",
    "number": "1275724767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1262 BOSTON RD",
            "address_2": "SUITE 1",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563602",
            "telephone_number": "718-617-2500",
            "fax_number": "718-617-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1262 BOSTON RD",
            "address_2": "SUITE 1",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104563602",
            "telephone_number": "718-617-2500",
            "fax_number": "718-617-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOSTON PEDIATRICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-08",
        "last_updated": "2013-01-31",
        "status": "A",
        "authorized_official_last_name": "CORNIELLE",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "LUIS",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "718-617-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "214716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03426235",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02087341",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03305057",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02269730",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boston Road Pediatrics, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Gifty Bosompem
• Claudia Naomi Bosque, PA-C
• Camille Bosquet, PA
• Nikolozi Bostashvili
• Boston Pediatrics PLLC
• Boston Road Care LLC
• Boston Road Medical Practice PC
• Boston Road Neighborhood Medical Care PC
• Boston Road Pharmacy Corp.
• Hannah M Boston, LMSW

• Pediatrics Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.