Organization
I M PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IWONA KATARZYNA MIENKO MD (PRESIDENT)
(718) 497-1565
Entity
Organization
Contact information
Practice address
6412 FRESH POND RD, RIDGEWOOD, NY 11385-3331
(718) 497-1565
(718) 497-1567
Mailing address
6412 FRESH POND RD, RIDGEWOOD, NY 11385-3331
(718) 497-1565
(718) 497-1567
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
217951
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02105622
—
NY
Enumeration date
11/30/2005
Last updated
02/24/2012
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