Healthcare Provider Details

I. General information

NPI: 1508876103
Provider Name (Legal Business Name): EASTSHORE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 NEW HAVEN AVE
MILFORD CT
06460-8220
US

IV. Provider business mailing address

1556 NEW HAVEN AVE
MILFORD CT
06460-8220
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-5941
  • Fax:
Mailing address:
  • Phone: 203-878-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAN PETER FUGAL
Title or Position: OWNER
Credential: MD
Phone: 203-878-5941