Healthcare Provider Details

I. General information

NPI: 1023281797
Provider Name (Legal Business Name): FIREFLY AFTER HOURS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HIGH RIDGE RD
STAMFORD CT
06905-1610
US

IV. Provider business mailing address

1011 HIGH RIDGE RD
STAMFORD CT
06905-1610
US

V. Phone/Fax

Practice location:
  • Phone: 203-968-1900
  • Fax:
Mailing address:
  • Phone: 203-968-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034756
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. STUART C. SILVERSTEIN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 203-550-9041