Organization
BOSTON PEDIATRICS, PLLC
Active
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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