Provider Demographics
NPI:1619031796
Name:SOUTHEASTERN CT NEPHROLOGY ASSOC PC
Entity Type:Organization
Organization Name:SOUTHEASTERN CT NEPHROLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-367-0087
Mailing Address - Street 1:88 NORWICH NEW LONDON TPK
Mailing Address - Street 2:SUITE 2
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382
Mailing Address - Country:US
Mailing Address - Phone:860-367-0087
Mailing Address - Fax:860-367-0117
Practice Address - Street 1:88 NORWICH NEW LONDON TPK
Practice Address - Street 2:SUITE 2
Practice Address - City:UNCASVILLE
Practice Address - State:CT
Practice Address - Zip Code:06382
Practice Address - Country:US
Practice Address - Phone:860-367-0087
Practice Address - Fax:860-367-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty