=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023281797
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIREFLY AFTER HOURS PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2008
-----------------------------------------------------
Last Update Date | 07/25/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 HIGH RIDGE RD
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06905-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-968-1900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 HIGH RIDGE RD
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06905-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-968-1900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. STUART C. SILVERSTEIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-550-9041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 034756
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------