Provider Demographics
NPI:1811021066
Name:CANDLEWOOD VALLEY PEDIATRICS, P.C.
Entity type:Organization
Organization Name:CANDLEWOOD VALLEY PEDIATRICS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DECRESCENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-355-8190
Mailing Address - Street 1:120 PARK LANE RD STE A101
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2444
Mailing Address - Country:US
Mailing Address - Phone:860-355-8190
Mailing Address - Fax:860-355-3856
Practice Address - Street 1:120 PARK LANE RD STE A101
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2444
Practice Address - Country:US
Practice Address - Phone:860-355-8190
Practice Address - Fax:860-355-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty