NPIMap

Organization Active NPI

Extraordinary Pediatrics, PC

  • Developmental - Behavioral Pediatrics Physician
  • New Hyde Park, NY
National Provider Identifier
1487817250
Registry record updated Jun 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
Legal business name
EXTRAORDINARY PEDIATRICS, PC
Practice address
5 Dakota Dr Ste 200
New Hyde Park, NY 11042-1109
Phone
(516) 621-2681
Fax
(516) 621-2403
NPI assigned
Jul 2, 2008
Last updated
Jun 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2023

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

Authorized official

Name
Beata Jalowski
Title
Revenue Cycle Manager
Phone
(718) 819-2830

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NY
Pediatrics Physician 208000000X NU
Developmental - Behavioral Pediatrics Physician 2080P0006X NU Primary
Pathology Specialist/Technologist 246Q00000X NU
Behavior Analyst 103K00000X NU
Behavior Technician 106S00000X NU

Addresses

Primary practice location

5 Dakota Dr Ste 200
New Hyde Park, NY 11042-1109

Mailing address

5 Dakota Dr Ste 200
New Hyde Park, NY 11042-1109
Phone (516) 621-2681

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.stmaryskids.org

National Provider Directory

National Provider Directory

Locations

1 Expressway Plz
Ste 106
Roslyn Heights, NY 11577
Phone (516) 621-2681

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687824000000",
    "number": "1487817250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 DAKOTA DR STE 200",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421109",
            "telephone_number": "516-621-2681",
            "fax_number": "516-621-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 DAKOTA DR STE 200",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110421109",
            "telephone_number": "516-621-2681",
            "fax_number": "516-621-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTRAORDINARY PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2023-06-27",
        "certification_date": "2023-06-27",
        "status": "A",
        "authorized_official_last_name": "JALOWSKI",
        "authorized_official_first_name": "BEATA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "718-819-2830"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "246Q00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Pathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.stmaryskids.org",
            "affiliation": "N",
            "address_1": "5 Dakota Dr Ste 200",
            "city": "New Hyde Park",
            "state": "NY",
            "country_code": "US",
            "postal_code": "110421109",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Hyde Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2023; 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.