Provider Demographics
NPI:1780246306
Name:PEDIATRIC HEALTH ASSOCIATES OF CONEECTICUT, LLC
Entity type:Organization
Organization Name:PEDIATRIC HEALTH ASSOCIATES OF CONEECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:JAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:860-513-1282
Mailing Address - Street 1:239 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1730
Mailing Address - Country:US
Mailing Address - Phone:860-513-1282
Mailing Address - Fax:860-331-8821
Practice Address - Street 1:239 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-1730
Practice Address - Country:US
Practice Address - Phone:860-436-4620
Practice Address - Fax:860-500-7642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-03
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty