Organization
STAYWELL PEDIATRIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS ETKIN M.D. (OWNER)
(230) 932-3227
Entity
Organization
Contact information
Practice address
365 ELM ST, WEST HAVEN, CT 06516-4217
(203) 932-3227
(203) 931-2847
Mailing address
365 ELM ST, WEST HAVEN, CT 06516-4217
(203) 932-3227
(203) 931-2847
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
000373
CT
Other
Enumeration date
07/27/2007
Last updated
07/27/2007
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