Provider Demographics
NPI:1740602515
Name:SMART START PEDIATRICS
Entity Type:Organization
Organization Name:SMART START PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:LAVALETTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-657-5800
Mailing Address - Street 1:27 SYCAMORE ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033
Mailing Address - Country:US
Mailing Address - Phone:860-657-5800
Mailing Address - Fax:860-633-6808
Practice Address - Street 1:27 SYCAMORE ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033
Practice Address - Country:US
Practice Address - Phone:860-657-5800
Practice Address - Fax:860-633-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037023208000000X
CT002159363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty