Organization
NIGHT LITE PEDIATRIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE MARIE LOPEZ (MANAGER CREDENTIALING/ENROLLMENT)
(516) 207-7936
Entity
Organization
Contact information
Practice address
11140 BEACH BLVD, JACKSONVILLE, FL 32246-4804
(321) 608-3595
Mailing address
1 HOLLOW LN STE 301, NEW HYDE PARK, NY 11042-1215
(516) 207-7936
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
113228411
—
FL
Enumeration date
12/17/2021
Last updated
01/21/2025
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