Provider Demographics
NPI:1376850081
Name:PEDIATRIC HEART SPECIALISTS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC HEART SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-426-0225
Mailing Address - Street 1:107 CHURCH HILL RD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1108
Mailing Address - Country:US
Mailing Address - Phone:203-426-0225
Mailing Address - Fax:203-426-0249
Practice Address - Street 1:107 CHURCH HILL RD
Practice Address - Street 2:SUITE 1A
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1108
Practice Address - Country:US
Practice Address - Phone:203-426-0225
Practice Address - Fax:203-426-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0349592080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT753985OtherCONNECTICARE
CT3V6335OtherHEALTHNET NORTHEAST
CT001349598Medicaid
CT010034959CT12OtherANTHEM BLUE CROSS
CTP3399905OtherOXFORD UNITED HEALTHCARE