Provider Demographics
NPI:1902011554
Name:PEDIATRIC ASSOCIATES OF NEW LONDON, LLC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF NEW LONDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAP
Authorized Official - Phone:860-442-8817
Mailing Address - Street 1:53 GRANITE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5917
Mailing Address - Country:US
Mailing Address - Phone:860-442-8817
Mailing Address - Fax:
Practice Address - Street 1:53 GRANITE ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5917
Practice Address - Country:US
Practice Address - Phone:860-442-8817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty