# MODERN ERA PEDIATRIC PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194817460
- **Authorized official:** MR. ANSELM CHIBUIKE ANYOHA MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (203) 371-4800

## Contact information

- **Practice address:** 3715 MAIN ST, SUITE 403, BRIDGEPORT, CT 06606-3618
- **Practice address phone:** (203) 371-4800
- **Practice address fax:** (203) 371-4900
- **Mailing address:** 3715 MAIN ST, SUITE 403, BRIDGEPORT, CT 06606-3618
- **Mailing address phone:** (203) 371-4800
- **Mailing address fax:** (203) 371-4900

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/28/2006
- **Last updated:** 11/09/2012