Healthcare Provider Details

I. General information

NPI: 1316068679
Provider Name (Legal Business Name): SHARON PEDIATRIC ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HOSPITAL HILL RD SUITE 1400
SHARON CT
06069-2095
US

IV. Provider business mailing address

PO BOX 157
SHARON CT
06069-0157
US

V. Phone/Fax

Practice location:
  • Phone: 860-364-5523
  • Fax: 860-364-0544
Mailing address:
  • Phone: 860-364-5523
  • Fax: 860-364-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: TOMAS TOMANEK
Title or Position: SENIOR PARTNER
Credential: M.D.
Phone: 860-364-5523