Provider Demographics
NPI:1881817211
Name:CONNECTICUT CHILDBIRTH CENTER INC
Entity type:Organization
Organization Name:CONNECTICUT CHILDBIRTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BLAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-748-6000
Mailing Address - Street 1:94 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6032
Mailing Address - Country:US
Mailing Address - Phone:203-748-6000
Mailing Address - Fax:203-748-6771
Practice Address - Street 1:94 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6032
Practice Address - Country:US
Practice Address - Phone:203-748-6000
Practice Address - Fax:203-748-6771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000245OtherLICENSE
CT000278OtherLICENSE
CT000111OtherLICENSE