Healthcare Provider Details

I. General information

NPI: 1013287218
Provider Name (Legal Business Name): PEDIATRICS PLUS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PECK ST
NORTH HAVEN CT
06473-2308
US

IV. Provider business mailing address

13 PECK ST
NORTH HAVEN CT
06473-2308
US

V. Phone/Fax

Practice location:
  • Phone: 203-239-4627
  • Fax: 203-234-8533
Mailing address:
  • Phone: 203-239-4627
  • Fax: 203-234-8533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number7148307-000
License Number StateCT

VIII. Authorized Official

Name: DR. ELSA L. STONE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-239-4627