Healthcare Provider Details

I. General information

NPI: 1104963966
Provider Name (Legal Business Name): RIVERSIDE PEDIATRICS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 E PUTNAM AVE BLDG 2, SUITE 100
GREENWICH CT
06878
US

IV. Provider business mailing address

1171 E PUTNAM AVE BLDG 2, SUITE 100
GREENWICH CT
06878
US

V. Phone/Fax

Practice location:
  • Phone: 203-629-5800
  • Fax: 203-629-7960
Mailing address:
  • Phone: 203-629-5800
  • Fax: 203-629-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042878
License Number StateCT

VIII. Authorized Official

Name: MRS. AMNA HILAL
Title or Position: SOLE OWNER
Credential: MD
Phone: 203-629-5800