Healthcare Provider Details

I. General information

NPI: 1790886091
Provider Name (Legal Business Name): PEDIATRIC SERVICES OF SPRINGFIELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NORTH MAIN STREET STE. 101
EAST LONGMEADOW MA
01028
US

IV. Provider business mailing address

250 NORTH MAIN STREET STE. 101
EAST LONGMEADOW MA
01028
US

V. Phone/Fax

Practice location:
  • Phone: 413-525-1870
  • Fax: 413-525-3883
Mailing address:
  • Phone: 413-525-1870
  • Fax: 413-525-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number45445
License Number StateMA

VIII. Authorized Official

Name: MR. NEIL NORDSTROM
Title or Position: DNP/OWNER
Credential:
Phone: 413-525-1870