MODERN ERA PEDIATRIC PRACTICE – NPI #1194817460
Pediatrics

A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

Health Care Provider Taxonomy Code for Pediatrics

MODERN ERA PEDIATRIC PRACTICE is a provider located in BRIDGEPORT, CT. NPPES has assigned the NPI number 1194817460 to MODERN ERA PEDIATRIC PRACTICE on September 28, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2080A0000X from the Health Care Provider Taxonomy code set, which is classified as Pediatrics, specializing in Adolescent Medicine

The NPI profile was previously updated about 14 years ago on Nov 09, 2012. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for MODERN ERA PEDIATRIC PRACTICE below.

NPI Profile for
MODERN ERA PEDIATRIC PRACTICE

NPI Number
1194817460
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MODERN ERA PEDIATRIC PRACTICE
Primary location
3715 MAIN ST
SUITE 403
BRIDGEPORT, CT 06606-3618
Phone: (203) 371-4800 Fax: (203) 371-4900
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
ANSELM ANYOHA
MEDICAL DIRECTOR
Phone: (203) 371-4800
Updated
Identifiers

Identifiers for MODERN ERA PEDIATRIC PRACTICE

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDCT001352799
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2080A0000X
- Pediatrics / Adolescent Medicine (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.