Provider Demographics
NPI:1376931311
Name:ST. VINCENT'S MULTISPECIALTY GROUP
Entity Type:Organization
Organization Name:ST. VINCENT'S MULTISPECIALTY GROUP
Other - Org Name:ST.VINCENT'S PODIATRY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-576-5412
Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5369
Mailing Address - Country:US
Mailing Address - Phone:203-576-5346
Mailing Address - Fax:
Practice Address - Street 1:1825 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5333
Practice Address - Country:US
Practice Address - Phone:203-377-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST.VINCENT'S MULTISPECIALTY GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty