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General NPI Number Information
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NPI Number | 1376850081
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Entity Type | Organization
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Legal Business Name | PEDIATRIC HEART SPECIALISTS, LLC
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 107 CHURCH HILL RD SUITE 1A
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City | SANDY HOOK
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State | CT
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Zip | 06482-1108
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Country | US
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Telephone | 203-426-0225
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Fax | 203-426-0249
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Provider Business Mailing Address
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Address Line | 107 CHURCH HILL RD SUITE 1A
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City | SANDY HOOK
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State | CT
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Zip | 06482-1108
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Country | US
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Telephone | 203-426-0225
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Fax | 203-426-0249
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. RICHARD A BERNING
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Credential | M.D.
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Telephone | 203-426-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | 034959
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License Number State | CT
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