# KIDS STATION PEDIATRICS

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

## Provider details

- **NPI number:** 1417153677
- **Authorized official:** DR. DONALD FRANCIS MORDAVSKY MD (CEO)
- **Authorized official phone:** (860) 643-7973

## Contact information

- **Practice address:** 191 MAIN ST, MANCHESTER, CT 06042-3556
- **Practice address phone:** (860) 643-7973
- **Practice address fax:** (860) 643-0175
- **Mailing address:** 191 MAIN ST, MANCHESTER, CT 06042-3556
- **Mailing address phone:** (860) 643-7973
- **Mailing address fax:** (860) 643-0175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | NULL | Yes |
| 2080A0000X | Pediatric Adolescent Medicine Physician | — | — | Yes |
| 363LP0200X | Pediatric Nurse Practitioner | — | CT | — |

## Other

- **Enumeration date:** 06/25/2007
- **Last updated:** 10/08/2013