OrganizationActive
Kids Station Pediatrics
NPI 1417153677 · Pediatric Adolescent Medicine Physician · Manchester, CT
Provider details
- NPI number
- 1417153677
- Entity type
- Organization
- Primary specialty
- Pediatric Adolescent Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Donald Mordavsky, Ceo(860) 643-7973
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Pediatric Nurse Practitioner363LP0200X
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
191 Main St
Manchester, CT 06042-3556
Phone: (860) 643-7973
Fax: (860) 643-0175
Street-level locationGet directions
Mailing address
191 Main St
Manchester, CT 06042-3556
Registry dates
- Enumerated
- 2007-06-25
- Last updated
- 2013-10-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.