Staywell Pediatric LLC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

000373 Issued in CT

Legal business name

STAYWELL PEDIATRIC LLC

Practice address

365 Elm St
West Haven, CT 06516-4217

Phone

(203) 932-3227

Fax

(203) 931-2847

NPI assigned

Jul 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Etkin, M.D.

Title

Owner

Phone

(230) 932-3227

Specialties & licenses 1

Addresses

Tax ID family

Staywell Pediatric LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Staywell Pediatric LLC

  • Pediatric Adolescent Medicine Physician
  • West Haven, CT
  • NPI 1841498839
  NPD tax ID

Practitioners 2

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

• Jobey Jacob, M.D.

  • Pediatrics Physician
  • West Haven, CT
  • NPI 1114167350
  NPD (past)
• Simone K. Simon, M.D.

  • Pediatrics Physician
  • West Haven, CT
  • NPI 1043397557
  NPD (past)

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

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185494400000",
    "number": "1255521019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 ELM ST",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164217",
            "telephone_number": "203-932-3227",
            "fax_number": "203-931-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 ELM ST",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164217",
            "telephone_number": "203-932-3227",
            "fax_number": "203-931-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAYWELL PEDIATRIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-27",
        "last_updated": "2007-07-27",
        "status": "A",
        "authorized_official_last_name": "ETKIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "230-932-3227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "000373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meaghan Stacy, PH.D.
• Aleshia A Stahl, APRN
• Stamford UC PC
• Patricia A Standish, LCSW
• Stanleyjwolfeddspc
• Staywell Pediatric LLC
• Robert Grant Steadman, MD
• Howard R. Steinberg, PH.D.
• Jadwiga Maja Stepczynski, M.D.
• Diana M Stout

• Pediatric Nurse Practitioner in West Haven, CT
• Providers in West Haven, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2007; 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.