Provider Demographics
NPI:1316354079
Name:GYNECOLOGIC CANCER CARE, LLC
Entity type:Organization
Organization Name:GYNECOLOGIC CANCER CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-970-0100
Mailing Address - Street 1:65 HIGH RIDGE ROAD
Mailing Address - Street 2:#653
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905
Mailing Address - Country:US
Mailing Address - Phone:203-970-0100
Mailing Address - Fax:
Practice Address - Street 1:65 HIGH RIDGE RD
Practice Address - Street 2:#653
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-3800
Practice Address - Country:US
Practice Address - Phone:203-970-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT052404207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty