Provider Demographics
NPI:1205844115
Name:NEW ENGLAND PEDIATRICS, LLP
Entity Type:Organization
Organization Name:NEW ENGLAND PEDIATRICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:KLENK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-972-5232
Mailing Address - Street 1:183 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4820
Mailing Address - Country:US
Mailing Address - Phone:203-972-5232
Mailing Address - Fax:203-972-5234
Practice Address - Street 1:183 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4820
Practice Address - Country:US
Practice Address - Phone:203-472-5232
Practice Address - Fax:203-972-5234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004052767Medicaid