Provider Demographics
NPI:1033157722
Name:LIFESPRING PEDIATRICS LLC
Entity Type:Organization
Organization Name:LIFESPRING PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYIRIMBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-426-9440
Mailing Address - Street 1:63 ARLEN WAY
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1104
Mailing Address - Country:US
Mailing Address - Phone:860-830-0238
Mailing Address - Fax:860-426-9646
Practice Address - Street 1:55 MERIDEN AVE
Practice Address - Street 2:SUITE 3A
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-3238
Practice Address - Country:US
Practice Address - Phone:860-426-9440
Practice Address - Fax:860-426-9646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT01157RMedicare UPIN