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NPI Code Detail

MEDICARE: GERIATRIC PROFESSIONAL GROUP, LLC

MEDICARE: GERIATRIC PROFESSIONAL GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2207R00000XInternal Medicine PhysicianCT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932295953
Entity Type Code : Organization
Provider Name (Legal Business Name) : GERIATRIC PROFESSIONAL GROUP, LLC
Provider Business Mailing Address
First Line : 4200 PARK AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-1049
Country : US
Telephone Number : 203-365-6473
Fax Number : 203-396-1039
Provider Business Practice Location Address
First Line : 4200 PARK AVE
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06604-1049
Country : US
Telephone Number : 203-365-6473
Fax Number : 203-396-1039
Authorized Official
Title or Position : PRESIDENT/CEO
Name : MR. ANDREW H BANOFF
Credential :
Telephone Number : 203-365-6400
Provider Enumeration Date : 10/05/2006
Last Update Date : 11/07/2016

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Directions to “GERIATRIC PROFESSIONAL GROUP, LLC ” Practice Location

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