Provider Demographics
NPI:1407422934
Name:APPLESEED PEDIATRIC AND ADOLESCENT MEDICINE
Entity Type:Organization
Organization Name:APPLESEED PEDIATRIC AND ADOLESCENT MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KYCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:860-558-3177
Mailing Address - Street 1:80 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3840
Mailing Address - Country:US
Mailing Address - Phone:860-200-1465
Mailing Address - Fax:860-200-3378
Practice Address - Street 1:80 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3840
Practice Address - Country:US
Practice Address - Phone:860-200-1465
Practice Address - Fax:860-200-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty