| NPI | 1417153677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD FRANCIS MORDAVSKY CEO 860-643-7973 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2013-10-08 |