Organization
PEDIATRICS AND ADOLESCENT MEDICINE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN CHARRON (PRACTICE ADMINISTRATOR)
(203) 795-4924
Entity
Organization
Contact information
Practice address
240 INDIAN RIVER RD, SUITE B-1, ORANGE, CT 06477-3649
(203) 795-4924
(203) 799-1554
Mailing address
240 INDIAN RIVER RD, SUITE B-1, ORANGE, CT 06477-3649
(203) 795-4924
(203) 799-1554
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4394003
—
CT
Enumeration date
08/31/2006
Last updated
10/19/2011
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