Provider Demographics
NPI:1194244921
Name:CONNECTICUT PEDIATRIC PARTNERSHIP LLC
Entity type:Organization
Organization Name:CONNECTICUT PEDIATRIC PARTNERSHIP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFNAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-762-3363
Mailing Address - Street 1:55 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4427
Mailing Address - Country:US
Mailing Address - Phone:203-762-3363
Mailing Address - Fax:
Practice Address - Street 1:55 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4427
Practice Address - Country:US
Practice Address - Phone:203-762-3363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT208000000X
208000000X
CT70315692-000208000000X
CT70315692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty