Healthcare Provider Details

I. General information

NPI: 1831197474
Provider Name (Legal Business Name): NEW ENGLAND DERMATOLOGY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 HARTFORD TPKE
VERNON CT
06066-4838
US

IV. Provider business mailing address

357 HARTFORD TPKE
VERNON CT
06066-4838
US

V. Phone/Fax

Practice location:
  • Phone: 860-871-9441
  • Fax: 860-871-0227
Mailing address:
  • Phone: 860-871-9441
  • Fax: 860-871-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. ROBERT DAVID GREENBERG
Title or Position: PRESIDENT
Credential: MD
Phone: 860-871-9441