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General NPI Number Information
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NPI Number | 1790886091
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SERVICES OF SPRINGFIELD, INC.
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 250 NORTH MAIN STREET STE. 101
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028
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Country | US
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Telephone | 413-525-1870
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Fax | 413-525-3883
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Provider Business Mailing Address
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Address Line | 250 NORTH MAIN STREET STE. 101
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028
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Country | US
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Telephone | 413-525-1870
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Fax | 413-525-3883
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Authorized Official
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Title or Position | DNP/OWNER
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Name | MR. NEIL NORDSTROM
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Credential |
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Telephone | 413-525-1870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 45445
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License Number State | MA
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