Provider Demographics
NPI:1023212032
Name:VILLAGE SQUARE INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:VILLAGE SQUARE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:FINNERTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-791-2221
Mailing Address - Street 1:2 ELIZABETH STREET
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801
Mailing Address - Country:US
Mailing Address - Phone:203-791-2221
Mailing Address - Fax:203-791-0682
Practice Address - Street 1:2 ELIZABETH STREET
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801
Practice Address - Country:US
Practice Address - Phone:203-791-2221
Practice Address - Fax:203-791-0682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty