KIDS STATION PEDIATRICS NPI 1417153677

NPI Information

NPI: 1417153677
Provider Name: KIDS STATION PEDIATRICS
Classification: Pediatrics - 2080A0000X
Entity Type: Organization

Specialization: Adolescent Medicine

Address:
191 MAIN ST
MANCHESTER, CT
ZIP 06042
Phone: (860) 643-7973
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KIDS STATION PEDIATRICS is an adolescent medicine pediatrics in Manchester, CT. The provider is a pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. KIDS STATION PEDIATRICS NPI is 1417153677. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

191 MAIN ST
MANCHESTER, CT
ZIP 06042-556
Phone: (860) 643-7973
Fax: (860) 643-0175

The provider's authorized official is Donald Francis Mordavsky .
The authorized official title is Ceo and has the following contact phone number (860) 643-7973.

The enumeration date for this NPI number is 6/25/2007 and was last updated on 10/8/2013.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0200X	Nurse Practitioner	Pediatrics		CONNECTICUT	No
2	2080A0000X	Pediatrics	Adolescent Medicine			Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	004132651	MEDICAID	CONNECTICUT

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: 11/14/2023

NPI Synchronization or Removal

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