Connecticut Neurodevelopmental Services

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

030847 Issued in CT

Legal business name

CONNECTICUT NEURODEVELOPMENTAL SERVICES

Practice address

134 Grandview Ave
Waterbury, CT 06708-2507

Phone

(203) 755-3279

Fax

(203) 755-3057

NPI assigned

Nov 22, 2006

Last updated

Sep 30, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alok Bhargava, M.D.NPI 1114980968

Title

Owner

Phone

(203) 755-3279

Specialties & licenses 7

Addresses

Locations

Practitioners 4

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.

• Alok Bhargava, M.D.

  • Neurology with Special Qualifications in Child Neurology Physician
  • Waterbury, CT
  • NPI 1114980968

  Pediatrics

  NPD (past) Authorized official
• Debra M Divenere, APRN, CPNP

  • Pediatric Nurse Practitioner
  • Waterbury, CT
  • NPI 1376559492

  Pediatrics

  NPD (past)
• Heather Christine Gatesman, FNP

  • Family Nurse Practitioner
  • Sandy Hook, CT
  • NPI 1093737249
  NPD (past)
• Kathleen Lea Sullivan, APRN

  • Family Nurse Practitioner
  • Waterbury, CT
  • NPI 1811204985
  NPD (past)

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380499200000",
    "number": "1467527580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 GRANDVIEW AVE",
            "address_2": "SUITE# 208",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082507",
            "telephone_number": "203-755-3279",
            "fax_number": "203-755-3057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082507",
            "telephone_number": "203-755-3279",
            "fax_number": "203-755-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT NEURODEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-09-30",
        "status": "A",
        "authorized_official_last_name": "BHARGAVA",
        "authorized_official_first_name": "ALOK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-755-3279",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "003467",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "004478",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "003467",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "004478",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "030847",
            "primary": false
        },
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "CT",
            "license": "030847",
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "CT",
            "license": "030847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurology with Special Qualifications in Child Neurology Physician in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2013; 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.