Provider Demographics
NPI:1861530750
Name:CENTER FOR PEDIATRIC MEDICINE
Entity type:Organization
Organization Name:CENTER FOR PEDIATRIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-790-0822
Mailing Address - Street 1:107 NEWTOWN ROAD
Mailing Address - Street 2:CENTER FOR PEDIATRIC MEDICINE PC SUITE 1D
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4146
Mailing Address - Country:US
Mailing Address - Phone:203-790-0822
Mailing Address - Fax:203-790-1808
Practice Address - Street 1:107 NEWTOWN ROAD
Practice Address - Street 2:CENTER FOR PEDIATRIC MEDICINE PC SUITE 1D
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4146
Practice Address - Country:US
Practice Address - Phone:203-790-0822
Practice Address - Fax:203-790-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty