Organization
THE PEDIATRIC CARE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN ADEYINKA M.D. (OWNER)
(860) 589-4501
Entity
Organization
Contact information
Practice address
780 FARMINGTON AVE, BRISTOL, CT 06010-3920
(860) 589-4501
(860) 589-4502
Mailing address
780 FARMINGTON AVE, BRISTOL, CT 06010-3920
(860) 589-4501
(860) 589-4502
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
038949
CT
363LP0200X
Pediatric Nurse Practitioner
002742
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528120094
—
CT
05
—
1679736870
—
CT
Enumeration date
01/17/2012
Last updated
01/17/2012
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