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General NPI Number Information
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NPI Number | 1972769032
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Entity Type | Organization
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Legal Business Name | GREENWICH NEONATOLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 5 PERRYRIDGE RD
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City | GREENWICH
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State | CT
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Zip | 06830-4608
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Country | US
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Telephone | 203-863-3515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 673
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City | OLD GREENWICH
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State | CT
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Zip | 06870-0673
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Country | US
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Telephone | 203-863-3515
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STYLIANOS THEOFANIDIS
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Credential | MD
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Telephone | 203-863-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 028038
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License Number State | CT
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