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SOUTHERN TIER PEDIATRICS PRACTICE, P.C.
NPI 1710902200
Pediatrics - Adolescent Medicine in Jamestown, NY

Active since July 13, 2006CLIA Certified · 2 labs
1684 FOOTE AVENUE EXT, JAMESTOWN, NY 14701(716) 661-9730(716) 661-9732 Get Directions Write a Review

NPPES record last updated: May 15, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Southern Tier Pediatrics Practice, P.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHERN TIER PEDIATRICS PRACTICE, P.C. (NPI 1710902200) is a healthcare organization registered as an adolescent medicine in Jamestown, New York and active in the NPI registry since July 2006. The organization holds 2 active CLIA laboratory certificates and lists Tariq M Khan, President, as its authorized official.

NPPES Registry Identity

NPI1710902200
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameSOUTHERN TIER PEDIATRICS PRACTICE, P.C.
Location Address1684 FOOTE AVENUE EXTJamestown, NY 14701-9385
Mailing Address1684 Foote Avenue ExtJamestown, NY 14701-9385 · (716) 661-9730 · Fax (716) 661-9732
Phone(716) 661-9730
Fax(716) 661-9732
Organization SubpartNo
Authorized OfficialTariq M KhanPresident · (716) 661-9730
Enumeration DateJuly 13, 2006
Last NPPES UpdateMay 15, 2013
✔ NPI 1710902200 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
License✔ Licensed in NY · 207469
Definition

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.

1684 FOOTE AVENUE EXT, Jamestown, NY 14701
Open in Google Maps ↗

Other Identifiers 2

Medicaid02690682NY
Medicaid01664951NY

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 2

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 33D0972508

Southern Tier Pediatrics Practice PC · Jamestown, NY
Active · expires Apr 9, 2028
CLIA Number33D0972508
Laboratory TypePhysician Office
Certificate Effective DateApril 10, 2026
Certificate Expiration DateApril 9, 2028
Laboratory DirectorDr. Tariq M. Khan
Laboratory Phone(716) 661-9730
Laboratory LocationSouthern Tier Pediatrics Practice PC1684 Foote Avenue Extension, Jamestown, NY 14701
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 33D2004706

Southern Tier Pediatrics Practice, PC (randolph) · Randolph, NY
Active · expires Mar 10, 2028
CLIA Number33D2004706
Laboratory TypePhysician Office
Certificate Effective DateMarch 11, 2026
Certificate Expiration DateMarch 10, 2028
Laboratory DirectorDr. Tariq M. Khan
Laboratory Phone(716) 661-9730
Laboratory LocationSouthern Tier Pediatrics Practice, PC (randolph)117 Main Street, Randolph, NY 14772
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NERISSA RICH FNP-C
Nurse Practitioner
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
MS. LYNDSEY MARIE CARLSON RPA-C
Physician Assistant
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
MS. NATALIE ANN TORRES PA-C
Physician Assistant
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
MRS. AMY REBECCA BEACH CRNP
Nurse Practitioner
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
ELLEN JOANNE REED PA
Physician Assistant
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
LEDA MARIE MARANGONI PA-C
Physician Assistant
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
KATIE MARIE BELL RPA-C
Physician Assistant
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730
AMY JO CALDWELL FNP-C
Nurse Practitioner
1684 FOOTE AVENUE EXT
JAMESTOWN, NY 14701
Chautauqua County (716) 661-9730

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southern Tier Pediatrics Practice, P.C.'s NPI number?

The NPI number for Southern Tier Pediatrics Practice, P.C. is 1710902200. It was assigned to this organization in the NPPES registry on July 13, 2006.

Where is Southern Tier Pediatrics Practice, P.C. located?

Southern Tier Pediatrics Practice, P.C. is located at 1684 Foote Avenue Ext, Jamestown, NY 14701. The listed phone number is (716) 661-9730.

What is Southern Tier Pediatrics Practice, P.C.'s specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Southern Tier Pediatrics Practice, P.C. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Southern Tier Pediatrics Practice, P.C. was last updated on May 15, 2013. NPI Profile syncs with the weekly NPPES data releases published by CMS.