Provider Demographics
NPI:1902676984
Name:ESSENTIAL PEDIATRICS INC.
Entity Type:Organization
Organization Name:ESSENTIAL PEDIATRICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, C/NDT
Authorized Official - Phone:203-391-3720
Mailing Address - Street 1:16 LANCER LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1731
Mailing Address - Country:US
Mailing Address - Phone:203-391-3270
Mailing Address - Fax:
Practice Address - Street 1:132 E PUTNAM AVE STE 24
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2724
Practice Address - Country:US
Practice Address - Phone:203-391-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service