Healthcare Provider Details

I. General information

NPI: 1912070012
Provider Name (Legal Business Name): GREENWICH PEDIATRIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W END AVE
OLD GREENWICH CT
06870-1642
US

IV. Provider business mailing address

8 W END AVE
OLD GREENWICH CT
06870-1642
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-3212
  • Fax: 203-637-3172
Mailing address:
  • Phone: 203-637-3212
  • Fax: 203-637-3172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: MS. JAN NEWMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 203-637-3212