Provider Demographics
NPI:1528128741
Name:PUTNAM GYNECOLOGY & OBSTETRICS OF GREENWICH PC
Entity type:Organization
Organization Name:PUTNAM GYNECOLOGY & OBSTETRICS OF GREENWICH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALASCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-622-0303
Mailing Address - Street 1:55 HOLLY HILL LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6074
Mailing Address - Country:US
Mailing Address - Phone:203-622-0303
Mailing Address - Fax:203-489-3980
Practice Address - Street 1:55 HOLLY HILL LN
Practice Address - Street 2:SUITE 130
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6074
Practice Address - Country:US
Practice Address - Phone:203-622-0303
Practice Address - Fax:203-489-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1358Medicare PIN