Organization Name: | EAST HAVEN PEDIATRICS P.C. |
NPI Number: | 1376624106 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHI-JEN CHENG (PRESIDENT PEDIATRICIAN) |
Mailing Address: | 300 Main St East Haven |
State: | CT US |
Postal Code: | 065122904 |
Phone Number: | 2034698882 |
Fax Number: | 2034679973 |
NPI Enumeration Date: | 10/18/2006 |
NPI Last Update Date: | 06/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |