GERIATRIC PROFESSIONAL GROUP, LLC (NPI# 1932295953) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1932295953 |
| Entity Type | Organization |
| Organization Name | GERIATRIC PROFESSIONAL GROUP, LLC |
| Practice Address |
4200 Park Ave Bridgeport CT 06604-1049 |
| Practice Telephone | 2033656473 |
| Practice Fax Number | 2033961039 |
| Mailing Telephone | 2033656473 |
| Mailing Fax Number | 2033961039 |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-11-07 |
| Authorized Official Name | MR. ANDREW H BANOFF (PRESIDENT/CEO) |
| Authorized Official Telephone | 2033656400 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207R00000X | Internal Medicine | CT | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 9233 | 05 |
| Street Address |
4200 PARK AVE |
| City | BRIDGEPORT |
| State | CT |
| Zip Code | 06604-1049 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083602346 | Jewish Home for The Elderly of Fairfield County Incorporated | Skilled Nursing Facility | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2005-10-11 |
| 1760012090 | Pamela Simpson | Licensed Practical Nurse | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2020-01-26 |
| 1053959965 | Lori Mihalov | Physical Therapist | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2019-12-11 |
| 1861048068 | Jessica Buckley | Physical Therapist | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2019-08-13 |
| 1194385682 | Diego Ernesto Aguillon | Physical Therapy Assistant | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2019-06-17 |
| 1962968347 | Rachneet Singh | Physical Therapist | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2019-02-11 |
| 1508337866 | Amber Bjerke | Physical Medicine & Rehabilitation | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2018-12-16 |
| 1366911588 | Madison Altermatt | Occupational Therapist | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2018-11-16 |
| 1851877518 | Bonnie Mullally | Physical Therapist | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2018-07-16 |
| 1205324266 | Mary Louise Evans | Physical Therapist | 4200 Park Ave, Bridgeport, CT 06604-1049 | 2018-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780163246 | Jill K Bebey | Pharmacist | 564 A Park Ave, Bridgeport, CT 06604 | 2018-08-07 |
| 1538663430 | Ryan Attar | Naturopath | 129 Columbia St, Bridgeport, CT 06604 | 2018-03-23 |
| 1487153375 | Fe Y Esperanza Home Care Services | Home Health | 2032 Main Street, Bridgeport, CT 06604 | 2018-02-06 |
| 1013423466 | Va.lu Able Home Care LLC | Registered Nurse | 1000 Lafayette Boulvard, Bridgeport, CT 06604 | 2017-12-21 |
| 1679970172 | Aarti Jawa | Dentist | 594 Pequonnoack Street, Bridgeport, CT 06604 | 2014-11-26 |
| 1932521473 | Anthony Santostefano | Dentist | 594 Pequonnock Street, Bridgeport, CT 06604 | 2014-01-18 |
| 1699011536 | Vanessa Frances Doyle | Naturopath | 115 Broad Street, C/o Center of Excellence, Bridgeport, CT 06604 | 2012-12-21 |
| 1942463302 | Joanna Conte Mcgary | Naturopath | 60 Lafayette Street, Naturopathic Medical Center University of Bridgeport, Bridgeport, CT 06604 | 2008-07-07 |
| 1346415221 | Jenna Lyn Blasi | Naturopath | 60 Lafayette, University of Bridgeport College of Naturopathic Medici, Bridgeport, CT 06604 | 2008-04-23 |
| 1275704462 | Watermark 3030 Park LLC | Skilled Nursing Facility | 3030 Park Ave, Bridgeport, CT 06604 | 2008-03-17 |
| Find all providers in zip 06604 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619525466 | Ilja Hulinsky Md PC | Internal Medicine | 4641 Main St Ste 3, Bridgeport, CT 06606-1827 | 2019-08-26 |
| 1801245931 | United Hospital Center, Inc. | Internal Medicine | 527 Medical Park Dr Ste 307, Bridgeport, WV 26330-9010 | 2016-06-09 |
| 1972957819 | Diana Rachel Stern Ferrante | Internal Medicine | 267 Grant St., Bridgeport, CT 06610 | 2016-04-18 |
| 1053711879 | Louis Ernest D'onofrio Jr. | Internal Medicine | 3180 Main St Unit 1b, Bridgeport, CT 06606-4237 | 2014-08-28 |
| 1548603384 | Gerald E. Hedley | Internal Medicine | 390 Charles Street Unit #101, Bridgeport, CT 06606 | 2013-04-11 |
| 1477849354 | Hervey Weitzman, Md, LLC | Internal Medicine | 4699 Main St Ste 213, Bridgeport, CT 06606-1830 | 2011-06-20 |
| 1598086506 | Saurabh Ranjan | Internal Medicine | 267 Grant Street, Gme 4th Floor, Bridgeport Hospital, Bridgeport, CT 06610 | 2010-06-14 |
| 1013143130 | Kevin B Panzer | Internal Medicine | 1381 Reservoir Ave., Bridgeport, CT 06606 | 2009-06-03 |
| 1720228455 | Wayne S Levin Md | Internal Medicine | 3690 Main St, Bridgeport, CT 06606-3610 | 2009-02-20 |
| 1992908537 | Jonathan Edmund Stanley | Internal Medicine | 527 Medical Park Dr Ste 302, Bridgeport, WV 26330-9009 | 2007-06-11 |
| Find all providers in BRIDGEPORT | ||||
| City | BRIDGEPORT |
| Zip Code | 06604 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.