Provider Demographics
NPI:1043266422
Name:GERIATRIC SERVICES OF CONNECTICUT, PC
Entity type:Organization
Organization Name:GERIATRIC SERVICES OF CONNECTICUT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KALCHTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:9143-765-5555
Mailing Address - Street 1:69 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4004
Mailing Address - Country:US
Mailing Address - Phone:914-376-5555
Mailing Address - Fax:914-964-1477
Practice Address - Street 1:69 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4004
Practice Address - Country:US
Practice Address - Phone:914-376-5555
Practice Address - Fax:914-964-1477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0418353140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric