Organization Active NPI

Her Wellness Health Center LLC

  • Obstetrics & Gynecology Physician
  • Wilton, CT
National Provider Identifier
1396268405
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
047101 Issued in CT
Legal business name
HER WELLNESS HEALTH CENTER LLC
Practice address
65 Old Ridgefield Rd
Wilton, CT 06897-3018
Phone
(203) 665-0900
Fax
(203) 665-0899
NPI assigned
Jul 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Kikelomo Otuyelu-Garritano, MDNPI 1992995310
Title
Physician
Phone
(914) 523-3469

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X 047101 CT Primary

Addresses

Primary practice location

65 Old Ridgefield Rd
Wilton, CT 06897-3018

Mailing address

19 Ground Pine Rd
Wilton, CT 06897-1917
Phone (914) 523-3469

Other identifiers 1

IdentifierTypeStateIssuer
004213865MedicaidCT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2134713Her Wellness Health Center, LLC65 Old Ridgefield Rd, Wilton, CT 06897Certificate of waiverAug 7, 2027

National Provider Directory

National Provider Directory

Locations

65 Old Ridgefield Rd
Wilton, CT 06897
Phone (203) 665-0900

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16202/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1500508800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1396268405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 GROUND PINE RD",
            "city": "WILTON",
            "state": "CT",
            "postal_code": "068971917",
            "telephone_number": "914-523-3469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 OLD RIDGEFIELD RD",
            "city": "WILTON",
            "state": "CT",
            "postal_code": "068973018",
            "telephone_number": "203-665-0900",
            "fax_number": "203-665-0899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HER WELLNESS HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OTUYELU-GARRITANO",
        "authorized_official_first_name": "KIKELOMO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "914-523-3469",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "047101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004213865",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.