Provider Demographics
NPI:1497959233
Name:NAUGATUCK PEDIATRICS, LLC
Entity Type:Organization
Organization Name:NAUGATUCK PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:203-729-2284
Mailing Address - Street 1:577 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-2808
Mailing Address - Country:US
Mailing Address - Phone:203-729-2186
Mailing Address - Fax:203-729-2660
Practice Address - Street 1:577 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-2808
Practice Address - Country:US
Practice Address - Phone:203-729-2186
Practice Address - Fax:203-729-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty