Healthcare Provider Details
I. General information
NPI: 1801806799
Provider Name (Legal Business Name): TARALYN CRONIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/09/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
520 WEST AVE
NORWALK CT
06850-4034
US
IV. Provider business mailing address
4637 MAIN STREET BROOKSIDE PEDIATRICS SUITE #4
BRIDGEPORT CT
06606
US
V. Phone/Fax
- Phone: 203-855-3632
- Fax: 203-855-3632
- Phone: 203-374-3001
- Fax: 203-372-6710
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | 043562 |
| License Number State | CT |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2080S0012X |
| Taxonomy | Pediatric Sleep Medicine Physician |
| License Number | 043562 |
| License Number State | CT |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: