Healthcare Provider Details

I. General information

NPI: 1801478086
Provider Name (Legal Business Name): GERIATRIC CONSULTANTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 13TH AVENUE PL NW
HICKORY NC
28601-2532
US

IV. Provider business mailing address

10 LOUGHLIN AVE
COS COB CT
06807-2616
US

V. Phone/Fax

Practice location:
  • Phone: 914-843-9637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRAD MARKOWITZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 914-843-9637