NPIMap

Organization Active NPI

Wildwood Pediatrics and Adolescent Medicine LLC

  • Pediatrics Physician
  • Essex, CT
National Provider Identifier
1750405023
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
WILDWOOD PEDIATRICS AND ADOLESCENT MEDICINE LLC
Practice address
One Wildwood Medical Center
Essex, CT 06426
Phone
(860) 767-0168
Fax
(860) 767-1803
NPI assigned
Mar 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Christopher W Goff, MDNPI 1275546988
Title
Partner
Phone
(860) 767-0168

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
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

One Wildwood Medical Center
Essex, CT 06426

Mailing address

One Wildwood Medical Center
Essex, CT 06426
Phone (860) 767-0168

National Provider Directory

National Provider Directory

Locations

30 Elm St
Old Saybrook, CT 06475
Phone (860) 358-4812

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1750405023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE WILDWOOD MEDICAL CENTER",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "06426",
            "telephone_number": "860-767-0168",
            "fax_number": "860-767-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE WILDWOOD MEDICAL CENTER",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "06426",
            "telephone_number": "860-767-0168",
            "fax_number": "860-767-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD PEDIATRICS AND ADOLESCENT MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GOFF",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "860-767-0168",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Essex, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.