Healthcare Provider Details

I. General information

NPI: 1962445205
Provider Name (Legal Business Name): GREENFIELD COUNTRY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 ROUTE 9N
GREENFIELD CENTER NY
12833-1711
US

IV. Provider business mailing address

3100 ROUTE 9N P.O.BOX 159
GREENFIELD CENTER NY
12833-1711
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-0615
  • Fax: 518-348-1279
Mailing address:
  • Phone: 518-268-0615
  • Fax: 518-348-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number239931
License Number StateNY

VIII. Authorized Official

Name: DR. JAMA LORYNN PEACOCK BIRSETT
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 518-258-0615