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General NPI Number Information
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NPI Number | 1467527580
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Entity Type | Organization
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Legal Business Name | CONNECTICUT NEURODEVELOPMENTAL SERVICES
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 134 GRANDVIEW AVE
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City | WATERBURY
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State | CT
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Zip | 06708-2507
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Country | US
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Telephone | 203-755-3279
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Fax | 203-755-3057
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Provider Business Mailing Address
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Address Line | 134 GRANDVIEW AVE SUITE# 208
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City | WATERBURY
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State | CT
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Zip | 06708-2507
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Country | US
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Telephone | 203-755-3279
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Fax | 203-755-3057
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Authorized Official
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Title or Position | OWNER
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Name | ALOK BHARGAVA
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Credential | M.D.
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Telephone | 203-755-3279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | 030847
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 030847
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 003467
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 003467
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 004478
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 004478
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License Number State | CT
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Taxonomy #7
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 030847
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License Number State | CT
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