Provider Demographics
NPI:1750305017
Name:THE CENTER FOR ADVANCED PEDIATRICS, P.C
Entity type:Organization
Organization Name:THE CENTER FOR ADVANCED PEDIATRICS, P.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:MIRCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-229-2009
Mailing Address - Street 1:761 MAIN AVE
Mailing Address - Street 2:SUITE 112 THE CENTER FOR ADVANCED PEDIATRICS, P.C.
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-229-2000
Mailing Address - Fax:203-840-9001
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-229-2000
Practice Address - Fax:203-840-9001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty