NPIMap

Organization Active NPI

Middlesex Hospital Dba Family Practice Group East Hampton

Doing business as Family Practice Group East Hampton

  • Family Medicine Physician
  • East Hampton, CT
National Provider Identifier
1114062114
Registry record updated Mar 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MIDDLESEX HOSPITAL DBA FAMILY PRACTICE GROUP EAST HAMPTON
Doing business as
Family Practice Group East Hampton
Practice address
42 E High St
East Hampton, CT 06424-1099
Phone
(860) 344-6394
Fax
(860) 344-6748
NPI assigned
Feb 20, 2007
Last updated
Mar 6, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
MIDDLESEX HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2019

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

Authorized official

Name
Marisa Pellerin
Title
Credentialing/Enrollment
Phone
(860) 358-4821

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X CT Primary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X CT
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X CT
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X CT
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X CT

Addresses

Primary practice location

42 E High St
East Hampton, CT 06424-1099

Mailing address

90 S Main St
Middletown, CT 06457-3649
Phone (860) 358-6394

Other names 1

  • Family Practice Group East Hampton Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Office of Prof Services16 organizations share this tax ID, including this one
Part of
Office of Prof Services

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1114062114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 S MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573649",
            "telephone_number": "860-358-6394",
            "fax_number": "860-358-6094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 E HIGH ST",
            "city": "EAST HAMPTON",
            "state": "CT",
            "postal_code": "064241099",
            "telephone_number": "860-344-6394",
            "fax_number": "860-344-6748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLESEX HOSPITAL DBA FAMILY PRACTICE GROUP EAST HAMPTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDDLESEX HOSPITAL",
        "enumeration_date": "2007-02-20",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "PELLERIN",
        "authorized_official_first_name": "MARISA",
        "authorized_official_title_or_position": "CREDENTIALING/ENROLLMENT",
        "authorized_official_telephone_number": "860-358-4821"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Practice Group East Hampton",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Practice Group East Hampton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Hampton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; 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.