Organization
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC SHAPIRO (VP, AREA CONTROLLER)
(410) 832-7790
Entity
Organization
Contact information
Practice address
1 EMERSON DR, KIMBERLY HALL NORTH, WINDSOR, CT 06095
(860) 688-6443
(860) 688-5230
Mailing address
PO BOX 62946, BALTIMORE, MD 21264-2946
(410) 494-7607
(610) 925-7387
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004126919
—
CT
05
—
004195021
—
CT
Enumeration date
08/24/2005
Last updated
08/05/2019
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