SHAKER PEDIATRICS PC; NPI #1336156223

Contact Information

SHAKER PEDIATRICS PC

10 CENTURY HILL DRIVE
LATHAM, NY 12110

Phone: 518-783-5563
Fax: 518-785-5708
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Adolescent Medicine	2080A0000X	37	Physician/Pediatric Medicine

Indicates primary specialty

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NPI Profile & details for SHAKER PEDIATRICS PC

NPI # 1336156223

LBN Legal business name SHAKER PEDIATRICS PC

Authorized official HENRY NEILLEY - (FIRST VICE PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 08/02/2006

Last updated 08/22/2020 - About 6 years ago

Identifiers

NY	Medicaid	00392741
NY	Medicaid	00962767
NY	Medicaid	01260746
NY	Medicaid	01332856
NY	Medicaid	01762674
NY	Medicaid	02094695
	Other	000401569001	BS HENRY NEILLEY MD
	Other	000401340001	BS SHEELA GRANEY MD
	Other	000401387001	BS WILLIAM A PETERSEN MD
	Other	10044836	CDPHP DAVID SHERWOOD MD
	Other	1007	CDPHP GROUP
	Other	10001463	CDPHP HENRY NEILLEY MD
	Other	10002139	CDPHP MARYLA WARSZAWA-AMB
	Other	10021167	CDPHP SHEELA GRANEY MD
	Other	10002804	CDPHP WM A PETERSEN MD
	Other	349679	MVP DAVID SHERWOOD MD
	Other	26207	MVP HENRY NEILLEY MD
	Other	26210	MVP MARYLA WARSZAWA-AMB
	Other	964787	MVP SHEELA GRANEY MD
	Other	26208	MVP WILLIAM A PETERSEN MD

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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SHAKER PEDIATRICS PC

Contact Information

Specialty

Adolescent Medicine

NPI Profile & details for SHAKER PEDIATRICS PC

Reviews for SHAKER PEDIATRICS PC