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General NPI Number Information
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NPI Number | 1831197474
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Entity Type | Organization
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Legal Business Name | NEW ENGLAND DERMATOLOGY ASSOCIATES, INC.
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 357 HARTFORD TPKE
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City | VERNON
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State | CT
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Zip | 06066-4838
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Country | US
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Telephone | 860-871-9441
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Fax | 860-871-0227
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Provider Business Mailing Address
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Address Line | 357 HARTFORD TPKE
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City | VERNON
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State | CT
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Zip | 06066-4838
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Country | US
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Telephone | 860-871-9441
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Fax | 860-871-0227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT DAVID GREENBERG
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Credential | MD
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Telephone | 860-871-9441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State | CT
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