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General NPI Number Information
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NPI Number | 1316465594
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Entity Type | Individual
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Provider Name | SPENCER PRESCOTT GREENE M.S. TCM
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Gender | Male
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 825 KINGS HWY E
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City | FAIRFIELD
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State | CT
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Zip | 06825-5419
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Country | US
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Telephone | 203-802-5453
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Fax |
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Provider Business Mailing Address
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Address Line | 3919 PARK AVE
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City | FAIRFIELD
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State | CT
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Zip | 06825-1254
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Country | US
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Telephone | 201-638-6338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 699
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License Number State | CT
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