Healthcare Provider Details

I. General information

NPI: 1780835991
Provider Name (Legal Business Name): GREENWICH AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HOLLY HILL LN
GREENWICH CT
06830-6074
US

IV. Provider business mailing address

PO BOX 181
CROTON FALLS NY
10519-0181
US

V. Phone/Fax

Practice location:
  • Phone: 860-833-2375
  • Fax:
Mailing address:
  • Phone: 860-833-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH L ROSENQUEST
Title or Position: ADMINISTRATOR
Credential:
Phone: 860-833-2375