Provider Demographics
NPI:1730932880
Name:OLD GREENWICH MEDICAL GROUP LLC
Entity type:Organization
Organization Name:OLD GREENWICH MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-637-5400
Mailing Address - Street 1:8 W END AVE
Mailing Address - Street 2:
Mailing Address - City:OLD GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06870-1642
Mailing Address - Country:US
Mailing Address - Phone:203-637-5400
Mailing Address - Fax:203-637-5408
Practice Address - Street 1:8 W END AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1642
Practice Address - Country:US
Practice Address - Phone:203-637-5400
Practice Address - Fax:203-637-5408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty