Provider Demographics
NPI:1467530337
Name:GREENWICH PODIATRY, INC
Entity Type:Organization
Organization Name:GREENWICH PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:401-884-2821
Mailing Address - Street 1:694 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3500
Mailing Address - Country:US
Mailing Address - Phone:401-884-2821
Mailing Address - Fax:401-884-4350
Practice Address - Street 1:694 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3500
Practice Address - Country:US
Practice Address - Phone:401-884-2821
Practice Address - Fax:401-884-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0404OtherNEIGHBORHOOD HEALTH PLANS
RI9004161Medicaid
RI0404OtherNEIGHBORHOOD HEALTH PLANS