Provider Demographics
NPI:1790122356
Name:GREENWICH GERIATRICS, LLC
Entity Type:Organization
Organization Name:GREENWICH GERIATRICS, LLC
Other - Org Name:GREENWICHGERIATRICS.COM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSLOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-413-3262
Mailing Address - Street 1:38 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-4515
Mailing Address - Country:US
Mailing Address - Phone:203-413-3262
Mailing Address - Fax:
Practice Address - Street 1:38 LAKE AVE
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-4515
Practice Address - Country:US
Practice Address - Phone:203-413-3262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51215207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty