Provider Demographics
NPI:1407917131
Name:NEW CANAAN PEDIATRICS LLC
Entity Type:Organization
Organization Name:NEW CANAAN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARRISON
Authorized Official - Middle Name:J
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-972-4250
Mailing Address - Street 1:173 EAST AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840
Mailing Address - Country:US
Mailing Address - Phone:203-972-4250
Mailing Address - Fax:203-801-2126
Practice Address - Street 1:173 EAST AVENUE
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840
Practice Address - Country:US
Practice Address - Phone:203-972-4250
Practice Address - Fax:203-801-2126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000121762701OtherUNITED HEALTH CARE
0011745800OtherBLUE CARE
2627988OtherCIGNA
ZP293OtherOXFORD
010017458CT01OtherANTHEM BC BS
2V6405OtherHEALTH NET
4257243OtherAETNA