| Geriatric Professional Group, Llc | |
|
4200 Park Ave Bridgeport CT 06604-1049 | |
| (203) 365-6473 | |
| (203) 396-1039 |
| Full Name | Geriatric Professional Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4200 Park Ave, Bridgeport, Connecticut |
| Authorized Official Name and Position | Andrew H Banoff (PRESIDENT/CEO) |
| Authorized Official Contact | 2033656400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Geriatric Professional Group, Llc 4200 Park Ave Bridgeport CT 06604-1049 Ph: (203) 365-6473 | Geriatric Professional Group, Llc 4200 Park Ave Bridgeport CT 06604-1049 Ph: (203) 365-6473 |
| NPI Number | 1932295953 |
|---|---|
| Provider Enumeration Date | 10/05/2006 |
| Last Update Date | 11/07/2016 |
| Medicare PECOS PAC ID | 8628973112 |
|---|---|
| Medicare Enrollment ID | O20031208000180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932295953 | NPI | - | NPPES |
| 9233 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (Connecticut) | Primary |
| Provider Name | Joseph F Fickes |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902838329 PECOS PAC ID: 4981690286 Enrollment ID: I20040422000552 |
| Provider Name | Pamela B Hoffman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366548778 PECOS PAC ID: 6507762093 Enrollment ID: I20040422000844 |
| Provider Name | Randi R Diamond |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700946472 PECOS PAC ID: 8426044363 Enrollment ID: I20040424000042 |
| Provider Name | Vittoria G Gassman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013987700 PECOS PAC ID: 4385667658 Enrollment ID: I20060112000614 |
| Provider Name | Kenneth Fine |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063508349 PECOS PAC ID: 5395743140 Enrollment ID: I20061110000169 |
| Provider Name | Allison B Ostroff |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1720262397 PECOS PAC ID: 5395860126 Enrollment ID: I20100916000340 |
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