Organization
THE PEDIATRIC CENTER
Active
Organization
THE PEDIATRIC CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JILL BEAUDRY (PRACTICE ADMINISTRATOR)
(203) 327-1055
Entity
Organization
Contact information
Practice address
126 MORGAN STREET, STAMFORD, CT 09605
(203) 327-1055
(203) 323-6177
Mailing address
126 MORGAN STREET, STAMFORD, CT 09605
(203) 327-1055
(203) 323-6177
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
001946
CT
363LP0200X
Pediatric Nurse Practitioner
001903
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004129781
—
CT
Enumeration date
12/16/2011
Last updated
12/16/2011
Update your record
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