Provider Demographics
NPI:1043376361
Name:GREENWALD, MERI LEE (PT)
Entity Type:Individual
Prefix:MISS
First Name:MERI
Middle Name:LEE
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 MASONS ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-2949
Mailing Address - Country:US
Mailing Address - Phone:860-536-7443
Mailing Address - Fax:
Practice Address - Street 1:168 BOSTON POST RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2163
Practice Address - Country:US
Practice Address - Phone:203-245-9293
Practice Address - Fax:203-245-2522
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004132174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080004132CT07OtherANTHEM
CT4229444OtherORTHONET FOR CIGNA
4258761OtherAETNA
CT1544151OtherFIRST HEALTH/COVENTRY
CT2V8207OtherHEALTHNET
CTP819154OtherOXFORD