1821630724 NPI number — GREENWICH MEDICAL ASSOCIATES, P.C.

Table of content: (NPI 1821630724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821630724 NPI number — GREENWICH MEDICAL ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENWICH MEDICAL ASSOCIATES, P.C.
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:
Provider Other Organization Name Type Code:
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:
1821630724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2001 BUTTERFIELD RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNERS GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60515-1069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-725-2799
Provider Business Mailing Address Fax Number:
833-842-5469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W PUTNAM AVE STE 435
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06830-6086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-861-7890
Provider Business Practice Location Address Fax Number:
203-861-7898
Provider Enumeration Date:
10/11/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ESPARZA
Authorized Official First Name:
LORENA
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE MANAGER
Authorized Official Telephone Number:
630-725-2764

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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