Organization
GREENWICH VILLAGE MEDICAL GROUP, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. F. RUSSELL KELLOGG M.D. (PRESIDENT)
(212) 604-8026
Entity
Organization
Contact information
Practice address
41 E 11TH ST FL 9, NEW YORK, NY 10003-4602
(212) 604-8026
(212) 604-7627
Mailing address
41 E 11TH ST FL 9, NEW YORK, NY 10003-4602
(212) 604-8026
(212) 604-7627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00588427
—
NY
Enumeration date
05/24/2007
Last updated
08/22/2020
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