Healthcare Provider Details

I. General information

NPI: 1831183177
Provider Name (Legal Business Name): STAMFORD PEDIATRIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SUMMER ST SUITE 301
STAMFORD CT
06905-5359
US

IV. Provider business mailing address

1275 SUMMER ST SUITE 301
STAMFORD CT
06905-5359
US

V. Phone/Fax

Practice location:
  • Phone: 203-324-4109
  • Fax: 203-969-1271
Mailing address:
  • Phone: 203-324-4109
  • Fax: 203-969-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER F HENKIND
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 203-324-4109