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General NPI Number Information
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NPI Number | 1700022654
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Entity Type | Organization
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Legal Business Name | VALLEY PEDIATRICS OF GREENWICH, LLC
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Dates
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Enumeration Date | 12/24/2008
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Last Update Date | 12/24/2008
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Provider Practice Location Address
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Address Line | 25 VALLEY DR
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City | GREENWICH
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State | CT
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Zip | 06831-5203
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Country | US
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Telephone | 203-622-4301
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Fax |
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Provider Business Mailing Address
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Address Line | 25 VALLEY DR
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City | GREENWICH
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State | CT
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Zip | 06831-5203
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Country | US
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Telephone | 203-622-4301
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. PAUL EDWARD JUAN
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Credential |
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Telephone | 203-622-4301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 032729
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License Number State | CT
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