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General NPI Number Information
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NPI Number | 1588778070
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Entity Type | Organization
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Legal Business Name | THE PEDIATRIC CENTER, P.C.
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 126 MORGAN ST
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City | STAMFORD
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State | CT
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Zip | 06905-5431
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Country | US
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Telephone | 203-327-1055
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Fax |
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Provider Business Mailing Address
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Address Line | 126 MORGAN ST
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City | STAMFORD
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State | CT
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Zip | 06905-5431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMIN
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Name | JENNIFER HOAR
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Credential |
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Telephone | 203-327-1055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5419
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License Number State | CT
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