Organization
STAYWELL PEDIATRIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS ETKIN M.D. (OWNER)
(203) 932-3227
Entity
Organization
Contact information
Practice address
365 ELM ST, WEST HAVEN, CT 06516-4217
(203) 932-3227
Mailing address
365 ELM ST, WEST HAVEN, CT 06516-4217
(203) 932-3227
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
01775
CT
Other
Enumeration date
07/11/2007
Last updated
07/11/2007
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