Provider Demographics
NPI:1053464487
Name:PEDIATRIC & MEDICAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC & MEDICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PEDIATRIC & MEDICAL ASSOC
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-865-3737
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-865-3737
Mailing Address - Fax:203-624-0751
Practice Address - Street 1:1 LONG WHARF DR
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-865-3737
Practice Address - Fax:203-624-0751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50PEDMEDICT01OtherBCBS ID 50PEDMEDICT01
CT004001913Medicaid