Basic Information
| Provider Information | |||||||||
| NPI: | 1083822480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DOCTORS PEDIATRIC PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 DANBURY RD | ||||||||
| Address2: | |||||||||
| City: | WILTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068974405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037623363 | ||||||||
| FaxNumber: | 2037621999 | ||||||||
| Practice Location | |||||||||
| Address1: | 55 DANBURY RD | ||||||||
| Address2: | |||||||||
| City: | WILTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068974405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037623363 | ||||||||
| FaxNumber: | 2037621999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 11/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | HUFNAGEL | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN VP | ||||||||
| AuthorizedOfficialTelephone: | 2037623363 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.