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General NPI Number Information
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NPI Number | 1912532953
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Entity Type | Organization
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Legal Business Name | CANTON GERIATRICS PLLC
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Dates
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Enumeration Date | 03/10/2020
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 461 CHERRY BROOK ROAD
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City | CANTON
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State | CT
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Zip | 06019
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Country | US
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Telephone | 845-527-8854
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Fax |
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Provider Business Mailing Address
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Address Line | 461 CHERRY BROOK ROAD
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City | CANTON
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State | CT
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Zip | 06019
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Country | US
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Telephone | 845-527-8854
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. TINA MARIE GARDNER
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Credential | M.D.
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Telephone | 845-527-8854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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