NPIMap

Organization Active NPI

New Haven Pediatric & Adolescent Medical Serv

  • Pediatrics Physician
  • New Haven, CT
National Provider Identifier
1962680934
Registry record updated Feb 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
0136872 Issued in CT
Legal business name
NEW HAVEN PEDIATRIC & ADOLESCENT MEDICAL SERV
Practice address
1423 Chapel St
Unit 2B
New Haven, CT 06511
Phone
(203) 752-0706
Fax
(203) 772-0387
NPI assigned
Feb 1, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2008

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

Authorized official

Name
Angel Jackson
Title
Office Manager
Phone
(203) 906-3854

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 0136872 CT Primary
Pediatric Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0200X 0002815 CT

Addresses

Primary practice location

1423 Chapel St
Unit 2B
New Haven, CT 06511

Mailing address

1423 Chapel St
Unit 2B
New Haven, CT 06511
Phone (203) 752-0706

Other names 1

  • Tamiko V Jackson MD Doing business as

National Provider Directory

National Provider Directory

Locations

1423 Chapel St
Ste 2B
New Haven, CT 06511
Phone (203) 641-3609

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1201824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201824000000",
    "number": "1962680934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1423 CHAPEL ST",
            "address_2": "UNIT 2B",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06511",
            "telephone_number": "203-752-0706",
            "fax_number": "203-772-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1423 CHAPEL ST",
            "address_2": "UNIT 2B",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "06511",
            "telephone_number": "203-752-0706",
            "fax_number": "203-772-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW HAVEN PEDIATRIC & ADOLESCENT MEDICAL SERV",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-01",
        "last_updated": "2008-02-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "203-906-3854"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "0136872",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "0002815",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tamiko V Jackson MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2008; 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.