METRO MEDICAL PRACTICE PC – NPI #1063098945
Pediatrics

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

METRO MEDICAL PRACTICE PC is a provider located in KEW GARDENS, NY. NPPES has assigned the NPI number 1063098945 to METRO MEDICAL PRACTICE PC on March 22, 2021. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2080A0000X from the Health Care Provider Taxonomy code set, which is classified as Pediatrics, specializing in Adolescent Medicine

The NPI profile was last updated on Mar 02, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for METRO MEDICAL PRACTICE PC below.

NPI Profile for
METRO MEDICAL PRACTICE PC

NPI Number
1063098945
Enumeration Date

(more than 5 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
METRO MEDICAL PRACTICE PC
Primary location
11607 METROPOLITAN AVE STE 102
KEW GARDENS, NY 11418-1018
Phone: (718) 850-9225 Fax: (718) 850-9226
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
NANCY WALLACH
OWNER
Phone: (718) 850-9225
Updated
Certification Date
Mar 02, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for METRO MEDICAL PRACTICE PC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidNY02244920
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2080A0000X
- Pediatrics / Adolescent Medicine (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.