Healthcare Provider Details

I. General information

NPI: 1376850081
Provider Name (Legal Business Name): PEDIATRIC HEART SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHURCH HILL RD SUITE 1A
SANDY HOOK CT
06482-1108
US

IV. Provider business mailing address

107 CHURCH HILL RD SUITE 1A
SANDY HOOK CT
06482-1108
US

V. Phone/Fax

Practice location:
  • Phone: 203-426-0225
  • Fax: 203-426-0249
Mailing address:
  • Phone: 203-426-0225
  • Fax: 203-426-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number034959
License Number StateCT

VIII. Authorized Official

Name: DR. RICHARD A BERNING
Title or Position: PHYSICIAN OWNER
Credential: M.D.
Phone: 203-426-0225