Provider Demographics
NPI:1932767050
Name:MED-GEM LLC
Entity Type:Organization
Organization Name:MED-GEM LLC
Other - Org Name:LORI L GREENWALD MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-761-6666
Mailing Address - Street 1:1 BARNARD LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2481
Mailing Address - Country:US
Mailing Address - Phone:860-761-6666
Mailing Address - Fax:860-761-1339
Practice Address - Street 1:1 BARNARD LN
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2481
Practice Address - Country:US
Practice Address - Phone:860-761-6666
Practice Address - Fax:860-761-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty