Healthcare Provider Details

I. General information

NPI: 1427197193
Provider Name (Legal Business Name): RIDGEFIELD PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 B GROVE ST
RIDGEFIELD CT
06877
US

IV. Provider business mailing address

38 B GROVE ST
RIDGEFIELD CT
06877
US

V. Phone/Fax

Practice location:
  • Phone: 203-438-9557
  • Fax: 203-438-7857
Mailing address:
  • Phone: 203-438-9557
  • Fax: 203-438-7857

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: MR. ANIL JOHN BRITTO
Title or Position: DOCTOR OWNER
Credential: MD
Phone: 203-438-9557