Healthcare Provider Details

I. General information

NPI: 1194244921
Provider Name (Legal Business Name): CONNECTICUT PEDIATRIC PARTNERSHIP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DANBURY RD
WILTON CT
06897-4427
US

IV. Provider business mailing address

55 DANBURY RD
WILTON CT
06897-4427
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-3363
  • Fax:
Mailing address:
  • Phone: 203-762-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70315692
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70315692-000
License Number StateCT

VIII. Authorized Official

Name: JOSEPH HUFNAGEL
Title or Position: CEO
Credential: DO
Phone: 203-762-3363