Active NPI
Her Wellness Health Center LLC
- Obstetrics & Gynecology Physician
- Wilton, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 047101
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kikelomo Otuyelu-Garritano, MD
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004213865 | Medicaid | CT |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2134713 | Her Wellness Health Center, LLC | Certificate of waiver | Aug 7, 2027 |
National Provider Directory
National Provider DirectoryLocations
65 Old Ridgefield Rd
Wilton, CT 06897
Phone (203) 665-0900
Interoperability endpoints
- 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.
-
- Obstetrics & Gynecology Physician
- Wilton, CT
- NPI 1992995310
-
- Women's Health Nurse Practitioner
- Manchester, CT
- NPI 1073143392
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.