NPIMap

Organization Active NPI

Pediatrics and Adolescent Medicine, P.C.

  • Pediatrics Physician
  • Orange, CT
National Provider Identifier
1033220108
Registry record updated Oct 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRICS AND ADOLESCENT MEDICINE, P.C.
Practice address
240 Indian River Rd
Suite B-1
Orange, CT 06477-3649
Phone
(203) 795-4924
Fax
(203) 799-1554
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jonathan Charron
Title
Practice Administrator
Phone
(203) 795-4924

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X CT Primary

Addresses

Primary practice location

240 Indian River Rd
Suite B-1
Orange, CT 06477-3649

Mailing address

240 Indian River Rd
Suite B-1
Orange, CT 06477-3649
Phone (203) 795-4924

Other identifiers 1

IdentifierTypeStateIssuer
4394003MedicaidCT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0097546Pediatrics & Adolescent Medicine240 Indian River Rd Ste B1, Orange, CT 06477Certificate of waiverJul 6, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1033220108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD",
            "address_2": "SUITE B-1",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-795-4924",
            "fax_number": "203-799-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD",
            "address_2": "SUITE B-1",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-795-4924",
            "fax_number": "203-799-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS AND ADOLESCENT MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "CHARRON",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "203-795-4924"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4394003",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.