Healthcare Provider Details

I. General information

NPI: 1588778070
Provider Name (Legal Business Name): THE PEDIATRIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MORGAN ST
STAMFORD CT
06905-5431
US

IV. Provider business mailing address

126 MORGAN ST
STAMFORD CT
06905-5431
US

V. Phone/Fax

Practice location:
  • Phone: 203-327-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5419
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HOAR
Title or Position: PRACTICE ADMIN
Credential:
Phone: 203-327-1055