Organization
BOSTON PEDIATRICS, PLLC
Active
Other names
Boston Road Pediatrics, PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JORGE LUIS CORNIELLE M.D. (MEDICAL DOCTOR)
(718) 617-2500
Entity
Organization
Contact information
Practice address
1262 BOSTON RD, SUITE 1, BRONX, NY 10456-3602
(718) 617-2500
(718) 617-0500
Mailing address
1262 BOSTON RD, SUITE 1, BRONX, NY 10456-3602
(718) 617-2500
(718) 617-0500
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
214716
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02087341
—
NV
05
—
02269730
—
NY
05
—
03305057
—
NY
05
—
03426235
—
NY
Enumeration date
08/08/2007
Last updated
01/31/2013
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