| NPI | 1508347162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI B WILDSTEIN Manager 203-304-4961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0006X Pediatrics, Developmental - Behavioral Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: CT 2442) |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2021-10-29 |