Black Rock Pediatrics
Pediatrics in Fairfield, CT. Organization (NPI-2).
NPI number1760629232
StatusActive
Last updated in NPPESJan 5, 2012
Details
- NPI
- 1760629232
- Entity type
- Organization (NPI-2)
- Legal business name
- Black Rock Pediatrics
- Organization subpart
- No
- Enumeration date
- Jan 20, 2009
- Last updated
- Jan 5, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208000000X | Pediatrics | 037492 | CT | Yes |
Practice location
1817 Black Rock TpkeSuite 206
Fairfield, CT 06825-3546
Phone 203-337-5333
Mailing address
1817 Black Rock TpkeSuite 206
Fairfield, CT 06825-3546
Phone 203-337-5333 · Fax 203-337-5360
Authorized official
Elin R Cohen
President
2036506030
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