Organization Active NPI

Island Pediatric Associates PLLC

  • Pediatric Adolescent Medicine Physician
  • Long Beach, NY
National Provider Identifier
1871624130
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
ISLAND PEDIATRIC ASSOCIATES PLLC
Practice address
120 West Park Avenue
Long Beach, NY 11561
Phone
(516) 889-1366
Fax
(516) 889-9135
NPI assigned
Mar 8, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ann Bruce
Title
Bookkeeper
Phone
(516) 889-1366

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X Primary

Addresses

Primary practice location

120 West Park Avenue
Long Beach, NY 11561

Mailing address

120 West Park Avenue
Suite 2J
Long Beach, NY 11561
Phone (516) 889-1366

National Provider Directory

National Provider Directory

Locations

120 W Park Ave
Ste 2J
Long Beach, NY 11561
Phone (516) 889-1366

Practitioners & affiliated clinicians

Practitioners 3

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": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871624130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 WEST PARK AVENUE",
            "address_2": "SUITE 2J",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "11561",
            "telephone_number": "516-889-1366",
            "fax_number": "516-889-9135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 WEST PARK AVENUE",
            "city": "LONG BEACH",
            "state": "NY",
            "postal_code": "11561",
            "telephone_number": "516-889-1366",
            "fax_number": "516-889-9135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISLAND PEDIATRIC ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "BOOKKEEPER",
        "authorized_official_telephone_number": "516-889-1366"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.