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Organization

CHILD & ADOLESCENT HEALTH CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JANE RUDOLPH MD (OWNER)
(203) 574-4747
Entity
Organization

Contact information

Practice address
179 ROSELAND AVE, WATERBURY, CT 06710
(203) 574-4747
(203) 574-2251
Mailing address
179 ROSELAND AVE, WATERBURY, CT 06710
(203) 574-4747
(203) 574-2251

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
000431
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4049987
CT
Enumeration date
11/30/2007
Last updated
03/30/2012
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