Healthcare Provider Details

I. General information

NPI: 1528077286
Provider Name (Legal Business Name): CANTERBURY PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MONROE TPKE
MONROE CT
06468-2276
US

IV. Provider business mailing address

401 MONROE TPKE
MONROE CT
06468-2276
US

V. Phone/Fax

Practice location:
  • Phone: 203-452-1063
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHN P TSALAPATANIS
Title or Position: MD
Credential: MD
Phone: 203-452-1063