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
Last updated
Jun 1, 2016By the provider in NPPES
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

National Provider Directory

National Provider Directory

Locations

324 Elm St
Ste 100B
Monroe, CT 06468

324 Elm St
Ste 202
Monroe, CT 06468

324 Elm St
Ste 2028
Monroe, CT 06468

240 Church St
Newington, CT 06111
Phone (860) 667-2256

225 Wyoming Ave
Torrington, CT 06790
Phone (860) 482-8563

265 Main St
Dalton, MA 01226
Phone (413) 684-3212

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

600 Lincoln Park E
Ste 202B
Cranford, NJ 07016

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

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": [],
    "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.