1801079371 NPI number — LORI L. GREENWALD, MD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801079371 NPI number — LORI L. GREENWALD, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LORI L. GREENWALD, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VANISHING VEINS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801079371
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BARNARD LN
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-2481
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-761-6666
Provider Business Mailing Address Fax Number:
860-761-2502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BARNARD LN
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-2481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-761-6666
Provider Business Practice Location Address Fax Number:
860-761-2502
Provider Enumeration Date:
12/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MICHAUD
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
860-761-6666

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  030092 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C03461 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".




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