NPIMap

Organization Active NPI

Practitioner Support Services LLP

  • Nurse Practitioner
  • Monroe, CT
National Provider Identifier
1114115706
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
PRACTITIONER SUPPORT SERVICES LLP
Practice address
324 Elm St Ste 202B
Monroe, CT 06468-2284
Phone
(203) 518-2124
NPI assigned
Oct 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Mr. David V Penry, NP-C
Title
President
Phone
(203) 518-2124

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

324 Elm St Ste 202B
Monroe, CT 06468-2284

Mailing address

PO Box 4058
Monroe, CT 06468-9998
Phone (203) 518-2124

Other identifiers 1

IdentifierTypeStateIssuer
004248870MedicaidCT

National Provider Directory

National Provider Directory

Locations

652 W Avon Rd
Avon, CT 06001
Phone (860) 673-2521

85 Stage Harbor Rd
Marlborough, CT 06447
Phone (860) 295-9531

324 Elm St
Ste 202A
Monroe, CT 06468
Phone (203) 268-5051

324 Elm St
Ste 2028
Monroe, CT 06468

324 Elm St
Ste 202
Monroe, CT 06468

324 Elm St
Ste 202B
Monroe, CT 06468
Phone (203) 880-5335

324 Elm St
Ste 100B
Monroe, CT 06468

324 Elm St
Ste 101A
Monroe, CT 06468
Phone (203) 261-9700

6448 Main St
Trumbull, CT 06611
Phone (203) 268-6204

439 Danbury Rd
#7
Wilton, CT 06897
Phone (203) 834-0199

503 Windsor Ave
#511
Windsor, CT 06095
Phone (860) 297-8600

90 Lindall St
Ste 8
Danvers, MA 01923

888 Worcester St
Ste 260
Wellesley, MA 02482
Phone (781) 690-6412

12250 E 12 Mile Rd
Warren, MI 48093
Phone (313) 432-1200

600 Lincoln Park E
Ste 202B
Cranford, NJ 07016

200 State Route 10 W
Succasunna, NJ 07876
Phone (973) 584-4000

Practitioners & affiliated clinicians

Practitioners 27

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

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1114115706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4058",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064689998",
            "telephone_number": "203-518-2124",
            "fax_number": "888-496-0267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 ELM ST STE 202B",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064682284",
            "telephone_number": "203-518-2124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRACTITIONER SUPPORT SERVICES LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-09",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "PENRY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-518-2124",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004248870",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; 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.