Provider Demographics
NPI:1659678183
Name:NAUGATUCK VALLEY WOMEN'S HEALTH SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:NAUGATUCK VALLEY WOMEN'S HEALTH SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-575-1811
Mailing Address - Street 1:687 STRAITS TPKE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2846
Mailing Address - Country:US
Mailing Address - Phone:203-575-1811
Mailing Address - Fax:203-575-1995
Practice Address - Street 1:687 STRAITS TPKE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2846
Practice Address - Country:US
Practice Address - Phone:203-575-1811
Practice Address - Fax:203-575-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004239639Medicaid
CT004151825Medicaid
CT008030460Medicaid