Provider Demographics
NPI:1407975675
Name:MILFORD PEDIATRIC GROUP, PC
Entity Type:Organization
Organization Name:MILFORD PEDIATRIC GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUSKAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-882-2066
Mailing Address - Street 1:50 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3565
Mailing Address - Country:US
Mailing Address - Phone:203-882-2066
Mailing Address - Fax:203-882-2074
Practice Address - Street 1:50 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3565
Practice Address - Country:US
Practice Address - Phone:203-882-2066
Practice Address - Fax:203-882-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001279174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty