WEST HAVEN PEDIATRICS LLC NPI 1578095634

NPI Information

NPI: 1578095634
Provider Name: WEST HAVEN PEDIATRICS, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 07D2102458

Address:
367 ELM ST
2ND FLOOR
WEST HAVEN, CT
ZIP 06516
Phone: (203) 932-3227
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WEST HAVEN PEDIATRICS, LLC is a primary care clinic center in West Haven, CT. WEST HAVEN PEDIATRICS, LLC NPI is 1578095634. The provider is registered as an organization entity type.

The provider's business location address is:

367 ELM ST
2ND FLOOR
WEST HAVEN, CT
ZIP 06516-217
Phone: (203) 932-3227

The provider's authorized official is Jobey Jacob .
The authorized official title is Owner/pediatrician and has the following contact phone number (203) 932-3227.

The CLIA number assigned to this NPI record is 07D2102458 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/29/2017 and was last updated on 3/29/2017.

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	261QP2300X	Clinic/Center	Primary Care	049082	CONNECTICUT	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	008061680	MEDICAID	CONNECTICUT
2	008035471	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: 4/28/2024

NPI Synchronization or Removal

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