Basic Information
| Provider Information | |||||||||
| NPI: | 1831183177 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STAMFORD PEDIATRIC ASSOCIATES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 SUMMER ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033244109 | ||||||||
| FaxNumber: | 2039691271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1275 SUMMER ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033244109 | ||||||||
| FaxNumber: | 2039691271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HENKIND | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2033244109 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.