Healthcare Provider Details

I. General information

NPI: 1861447799
Provider Name (Legal Business Name): KENT MED PEDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 N MAIN ST
KENT CT
06757-1511
US

IV. Provider business mailing address

38 N MAIN ST
KENT CT
06757-1511
US

V. Phone/Fax

Practice location:
  • Phone: 860-927-4365
  • Fax: 860-927-4366
Mailing address:
  • Phone: 860-927-4365
  • Fax: 860-927-4366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH P FROLKIS
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 860-350-7200