Organization
PEDIATRIC & ADOLESCENT MEDICAL ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE M HARDISH (BUSINESS MANAGER)
(315) 339-0401
Entity
Organization
Contact information
Practice address
117 W LIBERTY STREET, ROME, NY 13440
(315) 339-0401
(315) 339-2957
Mailing address
117 W LIBERTY STREET, ROME, NY 13440
(315) 339-0401
(315) 339-2957
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00606597
—
NY
Enumeration date
09/27/2006
Last updated
08/22/2020
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