Provider Demographics
NPI:1689074148
Name:PEDIATRIC HEALTH ASSOCIATES PC.
Entity Type:Organization
Organization Name:PEDIATRIC HEALTH ASSOCIATES PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DHINGRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-556-7956
Mailing Address - Street 1:48 MAPLEHURST CT
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1576
Mailing Address - Country:US
Mailing Address - Phone:347-556-7956
Mailing Address - Fax:
Practice Address - Street 1:576 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3015
Practice Address - Country:US
Practice Address - Phone:347-556-7956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407041007OtherNPPES