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PEDIATRIC ADVANCED CARE OF WEST HAVEN LLC
NPI 1942669916
Nurse Practitioner - Pediatrics in West Haven, CT

Active since February 18, 2016CLIA 07D2109806 · Waiver
755 CAMPBELL AVE, SUITE 2, WEST HAVEN, CT 06516(203) 889-2297 Get Directions Write a Review

NPPES record last updated: April 5, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Pediatric Advanced Care Of West Haven Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PEDIATRIC ADVANCED CARE OF WEST HAVEN LLC (NPI 1942669916) is a healthcare organization registered as a pediatrics in West Haven, Connecticut and active in the NPI registry since February 2016. The organization holds a CLIA Waiver certificate valid through March 1, 2028 and lists Elizabeth J Marcucio, Owner, as its authorized official.

NPPES Registry Identity

NPI1942669916
Entity TypeOrganization
Primary Taxonomy363LP0200X
Legal Business NamePEDIATRIC ADVANCED CARE OF WEST HAVEN LLC
Location Address755 CAMPBELL AVE, SUITE 2West Haven, CT 06516-3715
Mailing Address24 N Coe LnAnsonia, CT 06401-2818 · (203) 732-1662
Phone(203) 889-2297
Organization SubpartNo
Authorized OfficialElizabeth J MarcucioOwner · (203) 889-2297
Enumeration DateFebruary 18, 2016
Last NPPES UpdateApril 5, 2016
✔ NPI 1942669916 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in CT · 004531
755 CAMPBELL AVE, West Haven, CT 06516
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D2109806

Pediatric Advanced Care Of West Haven, LLC · West Haven, CT
Active · expires Mar 1, 2028
CLIA Number07D2109806
Laboratory TypePhysician Office
Certificate Effective DateMarch 2, 2026
Certificate Expiration DateMarch 1, 2028
Laboratory DirectorElizabeth J. Marcucio
Laboratory Phone(203) 889-2297
Laboratory LocationPediatric Advanced Care Of West Haven, LLC755 Campbell Ave, Suite 2, West Haven, CT 06516
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CONNECTICUT PHYSICAL THERAPY
Clinic/Center (Physical Therapy)
755 CAMPBELL AVE
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 931-9698
CAMPBELL MEDICAL SERVICES, LLC
Internal Medicine
755 CAMPBELL AVE, SUITE 3
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 937-1100
DR. WILLIAM E ROSNER M.D.
Internal Medicine
755 CAMPBELL AVE
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 931-2828
ILJA HULINSKY MD PHD
Internal Medicine (Endocrinology, Diabetes & Metabolism)
755 CAMPBELL AVE
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 374-4490
MS. DIANE E FAHEY APRN
Nurse Practitioner (Pediatrics)
755 CAMPBELL AVE, SUITE 2
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 889-2297
FAMILY PHYSICIANS OF WEST HAVEN,LLC
Internal Medicine
755 CAMPBELL AVE
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 931-2828
NICKESHA MARIE BROWN-FOKUO APRN
Nurse Practitioner (Family)
755 CAMPBELL AVE
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 937-1100
MRS. VIRGINIA LOUISE SHERRICK APRN, FNP-BC
Nurse Practitioner (Family)
755 CAMPBELL AVE
WEST HAVEN, CT 06516
South Central Connecticut Planning Region (203) 931-2828

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pediatric Advanced Care Of West Haven LLC's NPI number?

The NPI number for Pediatric Advanced Care Of West Haven LLC is 1942669916. It was assigned to this organization in the NPPES registry on February 18, 2016.

Where is Pediatric Advanced Care Of West Haven LLC located?

Pediatric Advanced Care Of West Haven LLC is located at 755 Campbell Ave Suite 2, West Haven, CT 06516. The listed phone number is (203) 889-2297.

What is Pediatric Advanced Care Of West Haven LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Does Pediatric Advanced Care Of West Haven LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D2109806) is associated with this NPI, valid through March 1, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pediatric Advanced Care Of West Haven LLC was last updated on April 5, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.