Healthcare Provider Details

I. General information

NPI: 1720248024
Provider Name (Legal Business Name): PEDIATRIC & FAMILY CENTER OR NATURAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

857 N MAIN STREET EXT #2
WALLINGFORD CT
06492-2465
US

IV. Provider business mailing address

857 N MAIN STREET EXT #2
WALLINGFORD CT
06492-2465
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-0444
  • Fax: 203-265-0472
Mailing address:
  • Phone: 203-265-0444
  • Fax: 203-265-0472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number000357
License Number StateCT

VIII. Authorized Official

Name: DR. JARED SKOWRON
Title or Position: OWNER
Credential: N.D.
Phone: 203-265-0444