NPIMap

Organization Active NPI

Staywell Pediatric LLC

  • Pediatric Adolescent Medicine Physician
  • West Haven, CT
National Provider Identifier
1841498839
Registry record updated Jul 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
01775 Issued in CT
Legal business name
STAYWELL PEDIATRIC LLC
Practice address
365 Elm St
West Haven, CT 06516-4217
Phone
(203) 932-3227
NPI assigned
Jul 11, 2007
Last updated
Jul 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2007

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

Authorized official

Name
Dr. Thomas Etkin, M.D.
Title
Owner
Phone
(203) 932-3227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X 01775 CT Primary

Addresses

Primary practice location

365 Elm St
West Haven, CT 06516-4217

Mailing address

365 Elm St
West Haven, CT 06516-4217
Phone (203) 932-3227

National Provider Directory

National Provider Directory
Tax ID family
Staywell Pediatric LLC2 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.

Practitioners & affiliated clinicians

Practitioners 2

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": "1184112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184112000000",
    "number": "1841498839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 ELM ST",
            "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": "365 ELM ST",
            "city": "WEST HAVEN",
            "state": "CT",
            "postal_code": "065164217",
            "telephone_number": "203-932-3227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAYWELL PEDIATRIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-11",
        "last_updated": "2007-07-11",
        "status": "A",
        "authorized_official_last_name": "ETKIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-932-3227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CT",
            "license": "01775",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jul 11, 2007; 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.