Provider Demographics
NPI:1922835545
Name:PREMIER PEDIATRICS OF CONNECTICUT
Entity type:Organization
Organization Name:PREMIER PEDIATRICS OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP, APRN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARKO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:718-431-4204
Mailing Address - Street 1:9 HUCKLEBERRY RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-1541
Mailing Address - Country:US
Mailing Address - Phone:718-431-4204
Mailing Address - Fax:
Practice Address - Street 1:1080 DAY HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1781
Practice Address - Country:US
Practice Address - Phone:860-580-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty