Provider Demographics
NPI:1083633119
Name:KEARNEY, GERALDINE M (PT)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:M
Last Name:KEARNEY
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 1:27 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-4405
Mailing Address - Country:US
Mailing Address - Phone:203-761-9710
Mailing Address - Fax:203-762-1349
Practice Address - Street 1:396 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-2024
Practice Address - Country:US
Practice Address - Phone:203-762-5623
Practice Address - Fax:203-762-9344
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4412174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V8285OtherHEALTHNET
CTANC1306OtherOXFORD
CT650000192Medicare PIN