East Avenue Pediatrics PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

038173 Issued in CT

Legal business name

EAST AVENUE PEDIATRICS PC

Practice address

148 East Ave
Suite 1L
Norwalk, CT 06851-5721

Phone

(203) 854-6993

Fax

(203) 854-9227

NPI assigned

Nov 3, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Libia Rueda-MatikNPI 1053483578

Title

Physician

Phone

(203) 854-6993

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Libia Rueda-Matik, MD

  • Pediatrics Physician
  • Norwalk, CT
  • NPI 1053483578
  NPD (past) Authorized official

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

{
    "created_epoch": "1320278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320278400000",
    "number": "1093092165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "148 EAST AVE",
            "address_2": "SUITE 1L",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068515721",
            "telephone_number": "203-854-6993",
            "fax_number": "203-854-9227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 EAST AVE",
            "address_2": "SUITE 1L",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068515721",
            "telephone_number": "203-854-6993",
            "fax_number": "203-854-9227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST AVENUE PEDIATRICS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-03",
        "last_updated": "2011-11-03",
        "status": "A",
        "authorized_official_last_name": "RUEDA-MATIK",
        "authorized_official_first_name": "LIBIA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "203-854-6993",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "038173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001381730",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Hieu Durand, M.D.
• Dva Renal Healthcare Inc
• Dynutrix, LLC
• Corynn Rose Dziezynski, PA-C
• East Avenue Medical Associates, LLC
• Gendai Echezona, MD
• Gregory Eckenrode, M.D.
• Marcia Eckerd, PH.D.
• William Marcus Eckerd, M.D.
• Eco-Life Acupuncture CT, PC

• Pediatrics Physician in Norwalk, CT
• Providers in Norwalk, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.