Active NPI
Pediatric Advanced Care of West Haven LLC
- Pediatric Nurse Practitioner
- West Haven, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 004531
- Legal business name
- PEDIATRIC ADVANCED CARE OF WEST HAVEN LLC
- Practice address
- 755 Campbell Ave
Suite 2
West Haven, CT 06516-3715 - Phone
- (203) 889-2297
- NPI assigned
- Feb 18, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Elizabeth J Marcucio, APRN
- Title
- Owner
- Phone
- (203) 889-2297
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 004531 | CT | Primary |
Addresses
Primary practice location
755 Campbell Ave
Suite 2
West Haven, CT 06516-3715
Mailing address
24 N Coe LN
Ansonia, CT 06401-2818
Phone (203) 732-1662
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D2109806 | Pediatric Advanced Care of West Haven, LLC | Certificate of waiver | Mar 1, 2028 |
National Provider Directory
National Provider DirectoryLocations
755 Campbell Ave
Ste 2
West Haven, CT 06516
Phone (203) 889-2297
Practitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- West Haven, CT
- NPI 1346750643
-
- Family Nurse Practitioner
- West Haven, CT
- NPI 1851919567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455753600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1459814400000",
"number": "1942669916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 N COE LN",
"city": "ANSONIA",
"state": "CT",
"postal_code": "064012818",
"telephone_number": "203-732-1662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 CAMPBELL AVE",
"address_2": "SUITE 2",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065163715",
"telephone_number": "203-889-2297"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PEDIATRIC ADVANCED CARE OF WEST HAVEN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-02-18",
"last_updated": "2016-04-05",
"status": "A",
"authorized_official_last_name": "MARCUCIO",
"authorized_official_first_name": "ELIZABETH",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "203-889-2297",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "APRN"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Pediatrics",
"state": "CT",
"license": "004531",
"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 Apr 5, 2016; 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.