Provider Demographics
NPI:1225370422
Name:THE GREENWICH MEDICAL SKINCARE AND LASER SPA
Entity Type:Organization
Organization Name:THE GREENWICH MEDICAL SKINCARE AND LASER SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CURTIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:203-637-0662
Mailing Address - Street 1:1345 E PUTNAM AVE
Mailing Address - Street 2:SUITE 2ND FLOOR
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1364
Mailing Address - Country:US
Mailing Address - Phone:203-637-0662
Mailing Address - Fax:203-637-0668
Practice Address - Street 1:1345 E. PUTNAM AVE
Practice Address - Street 2:THE GREENWICH MEDICAL SKINCARE AND LASER SPA
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870
Practice Address - Country:US
Practice Address - Phone:203-637-0662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005089261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty