Provider Demographics
NPI:1437212248
Name:RIVERSIDE OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:RIVERSIDE OBSTETRICS & GYNECOLOGY
Other - Org Name:RIVERSIDE OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:TURK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-637-3337
Mailing Address - Street 1:1200 E PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878-1430
Mailing Address - Country:US
Mailing Address - Phone:203-637-3337
Mailing Address - Fax:203-637-3307
Practice Address - Street 1:1200 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878-1430
Practice Address - Country:US
Practice Address - Phone:203-637-3337
Practice Address - Fax:203-637-3307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038686207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246569Medicaid
CTC03252Medicare ID - Type UnspecifiedMEDICARE GROUP #