Provider Demographics
NPI:1376520809
Name:GREENWICH PRIMARY CARE
Entity Type:Organization
Organization Name:GREENWICH PRIMARY CARE
Other - Org Name:S-CORP
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:GEOFFREY
Authorized Official - Last Name:TRACHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-692-9634
Mailing Address - Street 1:1175 STATE ROUTE 29
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-6109
Mailing Address - Country:US
Mailing Address - Phone:518-692-9634
Mailing Address - Fax:518-692-7586
Practice Address - Street 1:1175 STATE ROUTE 29
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-6109
Practice Address - Country:US
Practice Address - Phone:518-692-9634
Practice Address - Fax:518-692-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty