Provider Demographics
NPI:1790085983
Name:GREENWICH MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:GREENWICH MEDICAL SERVICES PC
Other - Org Name:GMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-961-8241
Mailing Address - Street 1:66 GLENBROOK RD
Mailing Address - Street 2:STE 400
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-8402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:66 GLENBROOK RD
Practice Address - Street 2:STE 400
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-8402
Practice Address - Country:US
Practice Address - Phone:203-961-8241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110007699Medicare PIN