Organization
NORTHEAST MEDICAL GROUP, PLLC
Active
Parent organization
NORTHEAST MEDICAL GROUP, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST MEDICAL GROUP, INC.
Authorized official
BEATA BIALCZAK (MANAGER)
(203) 384-3975
Entity
Organization
Contact information
Practice address
5 PERRYRIDGE RD, GREENWICH, CT 06830-4608
(203) 384-3975
Mailing address
PO BOX 415126, BOSTON, MA 02241-5126
(203) 384-3975
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NY
207R00000X
Internal Medicine Physician
Primary
—
—
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
04/12/2010
Last updated
01/10/2018
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