NPIMap

Organization Active NPI

Village Pediatric Group PLLC

  • Pediatrics Physician
  • Tuckahoe, NY
National Provider Identifier
1861626210
Registry record updated May 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
216946 Issued in NY
Legal business name
VILLAGE PEDIATRIC GROUP PLLC
Practice address
115 Main St
Suite 301
Tuckahoe, NY 10707-2911
Phone
(914) 771-7070
Fax
(914) 771-7073
NPI assigned
May 13, 2009
Last updated
May 13, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
VILLAGE PEDIATRIC GROUP PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 13, 2009

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

Authorized official

Name
Mrs. Kaira Rivera
Title
Billing Manager
Phone
(914) 771-7070

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 225800 NY
Pediatrics Physician 208000000X 216946 NY Primary

Addresses

Primary practice location

115 Main St
Suite 301
Tuckahoe, NY 10707-2911

Mailing address

115 Main St
Suite 301
Tuckahoe, NY 10707-2911
Phone (914) 771-7070

Other names 1

  • Village Pediatric Group PLLC Former legal business name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D1084447Village Pediatric Group115 Main St - Suite 301, Tuckahoe, NY 10707Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Part of
Village Pediatric Group PLLC

Locations

115 Main St
Ste 301
Tuckahoe, NY 10707
Phone (914) 771-7070

Practitioners & affiliated clinicians

Practitioners 6

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": "1242172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1242172800000",
    "number": "1861626210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 MAIN ST",
            "address_2": "SUITE 301",
            "city": "TUCKAHOE",
            "state": "NY",
            "postal_code": "107072911",
            "telephone_number": "914-771-7070",
            "fax_number": "914-771-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 MAIN ST",
            "address_2": "SUITE 301",
            "city": "TUCKAHOE",
            "state": "NY",
            "postal_code": "107072911",
            "telephone_number": "914-771-7070",
            "fax_number": "914-771-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE PEDIATRIC GROUP PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VILLAGE PEDIATRIC GROUP PLLC",
        "enumeration_date": "2009-05-13",
        "last_updated": "2009-05-13",
        "status": "A",
        "authorized_official_last_name": "RIVERA",
        "authorized_official_first_name": "KAIRA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "914-771-7070",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "225800",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "216946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Village Pediatric Group PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tuckahoe, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.