Kids Station Pediatrics
Kids Station Pediatrics provides Pediatric Adolescent Medicine Physician services in Manchester, Connecticut. Licensed in Connecticut. Registered with an NPI since 2007.
- Licensed in
- CT
- In the registry since
- 2007
- Specialties on file
- 2
Practice location Address checks out
191 Main StManchester, CT 06042-3556 Not confirmed with CMS for 12 years — call before visiting
Phone: (860) 643-7973
Fax: (860) 643-0175
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Pediatric Adolescent Medicine Physician (primary) | Taxonomy 2080A0000X |
|---|---|
| Pediatric Nurse Practitioner | Taxonomy 363LP0200X (CT) |
Record details
| NPI number | 1417153677 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Donald Mordavsky — Ceo · (860) 643-7973 |
| NPI enumerated | June 25, 2007 |
| Last updated in NPPES | October 8, 2013 |
| Mailing address | 191 Main St, Manchester, CT 06042-3556 |