NPIMap

Organization Active NPI

Candlewood Valley Pediatrics, P.C.

  • Pediatrics Physician
  • New Milford, CT
National Provider Identifier
1811021066
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CANDLEWOOD VALLEY PEDIATRICS, P.C.
Practice address
120 Park Lane Rd Ste A101
New Milford, CT 06776-2444
Phone
(860) 355-8190
Fax
(860) 355-3856
NPI assigned
Mar 16, 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
Mrs. Marilyn C Decrescenzo
Title
Managed Care Coordinator
Phone
(860) 355-8190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

120 Park Lane Rd Ste A101
New Milford, CT 06776-2444

Mailing address

120 Park Lane Rd Ste A101
New Milford, CT 06776-2444
Phone (860) 355-8190

Other names 1

  • candlewood valley pediatrics Former legal business name

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
07D0928032Candlewood Valley Pediatrics120 Park Lane, New Milford, CT 06776Certificate of waiverMay 6, 2027

National Provider Directory

National Provider Directory

Locations

120 Park Lane Rd
Ste A101
New Milford, CT 06776
Phone (860) 355-8190

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811021066",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 PARK LANE RD STE A101",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762444",
            "telephone_number": "860-355-8190",
            "fax_number": "860-355-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 PARK LANE RD STE A101",
            "city": "NEW MILFORD",
            "state": "CT",
            "postal_code": "067762444",
            "telephone_number": "860-355-8190",
            "fax_number": "860-355-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANDLEWOOD VALLEY PEDIATRICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DECRESCENZO",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGED CARE COORDINATOR",
        "authorized_official_telephone_number": "860-355-8190",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "candlewood valley pediatrics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in New Milford, 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.
  • 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.