Provider Demographics
NPI:1164895314
Name:NAUGATUCK VALLEY WOMENS HEALTH SPECIALISTS PC
Entity Type:Organization
Organization Name:NAUGATUCK VALLEY WOMENS HEALTH SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL ASSISTNAT
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENDARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-575-1811
Mailing Address - Street 1:686 STRAITS TURNPIKE
Mailing Address - Street 2:2A
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762
Mailing Address - Country:US
Mailing Address - Phone:203-575-1811
Mailing Address - Fax:203-575-1995
Practice Address - Street 1:686 STRAITS TURNPIKE
Practice Address - Street 2:2A
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762
Practice Address - Country:US
Practice Address - Phone:203-575-1811
Practice Address - Fax:203-575-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004395514Medicaid
CO1191OtherMEDICARE