NPIMap

Organization Active NPI

West Haven Pediatrics, LLC

  • Primary Care Clinic/Center
  • West Haven, CT
National Provider Identifier
1578095634
Registry record updated Mar 29, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
049082 Issued in CT
Legal business name
WEST HAVEN PEDIATRICS, LLC
Practice address
367 Elm St
2ND Floor
West Haven, CT 06516-4217
Phone
(203) 932-3227
NPI assigned
Mar 29, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2017

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

Authorized official

Name
Dr. Jobey Jacob
Title
Owner/Pediatrician
Phone
(203) 932-3227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 049082 CT Primary

Addresses

Primary practice location

367 Elm St
2ND Floor
West Haven, CT 06516-4217

Mailing address

367 Elm St
2ND Floor
West Haven, CT 06516-4217
Phone (203) 932-3227

Other identifiers 2

IdentifierTypeStateIssuer
008061680MedicaidCT
008035471MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
West Haven Pediatrics2 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.

Locations

367 Elm St
#2
West Haven, CT 06516
Phone (203) 932-3227

NPI Registry JSON

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490745600000",
    "number": "1578095634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "367 ELM ST",
            "address_2": "2ND FLOOR",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164217",
            "telephone_number": "203-932-3227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "367 ELM ST",
            "address_2": "2ND FLOOR",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164217",
            "telephone_number": "203-932-3227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST HAVEN PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-29",
        "last_updated": "2017-03-29",
        "status": "A",
        "authorized_official_last_name": "JACOB",
        "authorized_official_first_name": "JOBEY",
        "authorized_official_title_or_position": "OWNER/PEDIATRICIAN",
        "authorized_official_telephone_number": "203-932-3227",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "049082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008061680",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008035471",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2017; 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.