Provider Demographics
NPI:1982826574
Name:GLENVILLE MEDICAL ASSOCIATES P.C
Entity Type:Organization
Organization Name:GLENVILLE MEDICAL ASSOCIATES P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-531-1808
Mailing Address - Street 1:7 RIVERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06831
Mailing Address - Country:US
Mailing Address - Phone:203-531-1808
Mailing Address - Fax:203-531-8326
Practice Address - Street 1:7 RIVERSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831
Practice Address - Country:US
Practice Address - Phone:203-531-1808
Practice Address - Fax:203-531-8326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty