Healthcare Provider Details

I. General information

NPI: 1861530750
Provider Name (Legal Business Name): CENTER FOR PEDIATRIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 NEWTOWN ROAD CENTER FOR PEDIATRIC MEDICINE PC SUITE 1D
DANBURY CT
06810-4146
US

IV. Provider business mailing address

107 NEWTOWN ROAD CENTER FOR PEDIATRIC MEDICINE PC SUITE 1D
DANBURY CT
06810-4146
US

V. Phone/Fax

Practice location:
  • Phone: 203-790-0822
  • Fax: 203-790-1808
Mailing address:
  • Phone: 203-790-0822
  • Fax: 203-790-1808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOAN A MAGNER
Title or Position: PRESIDENT
Credential: MD
Phone: 203-790-0822