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EAST AVENUE PEDIATRICS PC NPI 1093092165


NPI Information

NPI: 1093092165
Provider Name: EAST AVENUE PEDIATRICS PC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 07D2042246

Address:
148 EAST AVE
SUITE 1L
NORWALK, CT
ZIP 06851
Phone: (203) 854-6993
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EAST AVENUE PEDIATRICS PC is a pediatrics in Norwalk, CT. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. EAST AVENUE PEDIATRICS PC NPI is 1093092165. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

148 EAST AVE
SUITE 1L
NORWALK, CT
ZIP 06851-721
Phone: (203) 854-6993
Fax: (203) 854-9227

The provider's authorized official is Libia Rueda-matik .
The authorized official title is Physician and has the following contact phone number (203) 854-6993.

The CLIA number assigned to this NPI record is 07D2042246 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/3/2011 and was last updated on 11/3/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatrics038173CONNECTICUTYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1001381730MEDICAIDCONNECTICUT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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