Healthcare Provider Details

I. General information

NPI: 1407766280
Provider Name (Legal Business Name): POP-UP PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 MIX AVE APT C
HAMDEN CT
06514-2126
US

IV. Provider business mailing address

2335 DIXWELL AVE STE 2 1042
HAMDEN CT
06514-2100
US

V. Phone/Fax

Practice location:
  • Phone: 203-809-6871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THERESA HOWARD
Title or Position: OWNER
Credential:
Phone: 203-809-6871