| Organization Name: | HEARTLAND PEDIATRICS OF LAKE PLACID, INC. |
| NPI Number: | 1265453203 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAJESWARI SONNI (PRESIDENT/ MEDICAL DIRECTOR) |
| Mailing Address: | 344 E Royal Palm St Suite # 3 Lake Placid |
| State: | FL US |
| Postal Code: | 338525020 |
| Phone Number: | 8636991414 |
| Fax Number: | 8636999790 |
| NPI Enumeration Date: | 07/23/2006 |
| NPI Last Update Date: | 05/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |