Healthcare Provider Details

I. General information

NPI: 1952320475
Provider Name (Legal Business Name): JOSHUA PEDER RISING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 ORANGE ST # 1
NEW HAVEN CT
06511-3824
US

IV. Provider business mailing address

637 ORANGE ST # 1
NEW HAVEN CT
06511-3824
US

V. Phone/Fax

Practice location:
  • Phone: 203-535-9983
  • Fax:
Mailing address:
  • Phone: 203-535-9983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number046018
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: