| NPI | 1104294644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOBEY JACOB Owner 203-932-3227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2015-12-24 |