# CONNECTICUT CHILDREN'S SPECIALTY GROUP, INC.

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

## Provider details

- **NPI number:** 1568056984
- **Authorized official:** KELLI ALLEN-DUNN (DIRECTOR, MEDICAL STAFF & CREDENTIA)
- **Authorized official phone:** (860) 837-5561

## Contact information

- **Practice address:** 131 NEW LONDON TPKE STE 200, GLASTONBURY, CT 06033-2246
- **Practice address phone:** (860) 837-9628
- **Mailing address:** 10 COLUMBUS BLVD FL 4, HARTFORD, CT 06106-1976
- **Mailing address phone:** (186) 083-7561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | NULL | — |
| 2080N0001X | Neonatal-Perinatal Medicine Physician | — | — | — |
| 2080P0203X | Pediatric Critical Care Medicine Physician | — | NULL | — |
| 2080P0203X | Pediatric Critical Care Medicine Physician | — | — | — |
| 2080P0204X | Pediatric Emergency Medicine (Pediatrics) Physician | — | NULL | — |
| 2080P0204X | Pediatric Emergency Medicine (Pediatrics) Physician | — | — | — |
| 2080P0205X | Pediatric Endocrinology Physician | — | NULL | — |
| 2080P0205X | Pediatric Endocrinology Physician | — | — | — |
| 2080P0206X | Pediatric Gastroenterology Physician | — | NULL | — |
| 2080P0206X | Pediatric Gastroenterology Physician | — | — | — |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | NULL | — |
| 2080P0207X | Pediatric Hematology & Oncology Physician | — | — | — |
| 2080P0208X | Pediatric Infectious Diseases Physician | — | NULL | — |
| 2080P0208X | Pediatric Infectious Diseases Physician | — | — | — |
| 2080P0210X | Pediatric Nephrology Physician | — | NULL | — |
| 2080P0210X | Pediatric Nephrology Physician | — | — | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | NULL | — |
| 2080P0214X | Pediatric Pulmonology Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | NULL | — |
| 363LP0200X | Pediatric Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/25/2021
- **Last updated:** 12/05/2023