Provider Demographics
NPI:1467471300
Name:GREENWICH OTOLARYNGOLOGY, PC
Entity Type:Organization
Organization Name:GREENWICH OTOLARYNGOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-629-5500
Mailing Address - Street 1:4 DEARFIELD DR
Mailing Address - Street 2:STE 104
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831-5351
Mailing Address - Country:US
Mailing Address - Phone:203-629-5500
Mailing Address - Fax:203-629-8244
Practice Address - Street 1:4 DEARFIELD DR
Practice Address - Street 2:STE 104
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-5351
Practice Address - Country:US
Practice Address - Phone:203-629-5500
Practice Address - Fax:203-629-8244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035952207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG48244Medicare UPIN