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General NPI Number Information
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NPI Number | 1487809901
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Entity Type | Organization
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Legal Business Name | VILLAGE PEDIATRICS
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 323 RIVERSIDE AVE STE 2
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City | WESTPORT
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State | CT
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Zip | 06880-4825
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Country | US
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Telephone | 201-221-7337
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Fax | 888-354-7455
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Provider Business Mailing Address
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Address Line | 323 RIVERSIDE AVE STE 2
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City | WESTPORT
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State | CT
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Zip | 06880-4825
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Country | US
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Telephone | 201-221-7337
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Fax | 888-354-7455
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Authorized Official
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Title or Position | OWNER
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Name | C. NICOLE GORMAN
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Credential | MD
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Telephone | 203-221-7337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 042135
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License Number State | CT
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