Provider Demographics
NPI:1720248024
Name:PEDIATRIC & FAMILY CENTER OR NATURAL MEDICINE
Entity Type:Organization
Organization Name:PEDIATRIC & FAMILY CENTER OR NATURAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOWRON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:203-265-0444
Mailing Address - Street 1:857 N MAIN STREET EXT
Mailing Address - Street 2:#2
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2465
Mailing Address - Country:US
Mailing Address - Phone:203-265-0444
Mailing Address - Fax:203-265-0472
Practice Address - Street 1:857 N MAIN STREET EXT
Practice Address - Street 2:#2
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2465
Practice Address - Country:US
Practice Address - Phone:203-265-0444
Practice Address - Fax:203-265-0472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000357175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty