Provider Demographics
NPI:1881563906
Name:PM PEDIATRICS OF FLORIDA, LLC
Entity type:Organization
Organization Name:PM PEDIATRICS OF FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR MANAGER OF RCM OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-207-7919
Mailing Address - Street 1:1 HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1220
Mailing Address - Country:US
Mailing Address - Phone:516-869-0650
Mailing Address - Fax:
Practice Address - Street 1:801 S UNIVERSITY DR STE D101
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3366
Practice Address - Country:US
Practice Address - Phone:954-902-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109798201Medicaid