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General NPI Number Information
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NPI Number | 1780732289
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Entity Type | Organization
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Legal Business Name | WILLIMAUTIC PEDIATRICS PC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 70 MANSFIELD AVENUE
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City | WILLIMAUTIC
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State | CT
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Zip | 06226-2020
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Country | US
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Telephone | 860-456-1132
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Fax | 860-456-2023
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Provider Business Mailing Address
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Address Line | 70 MANSFIELD AVENUE
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City | WILLIMAUTIC
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State | CT
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Zip | 06226-2020
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Country | US
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Telephone | 860-456-1132
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Fax | 860-456-2023
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DAMARIS R ORTIZ
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Credential |
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Telephone | 860-456-1132
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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 |
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License Number State | CT
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