Individual provider Active NPI

Andre Shomorony, MD

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Greenwich, CT
National Provider Identifier
1265995088
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianTaxonomy code 2082S0099X
License
81708 Issued in CT
Practice address
116 Mason St
Greenwich, CT 06830-2607
Phone
(203) 661-1715
NPI assigned
Apr 9, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X 81708 CT Primary

Addresses

Primary practice location

116 Mason St
Greenwich, CT 06830-2607

Mailing address

116 Mason St
Greenwich, CT 06830-2607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240606002831 PA Practitioner - Otolaryngology 2163964057 Reassigns benefits to 1 organization
I20260626004069 CT Practitioner - Otolaryngology 2163964057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Harvard Medical School, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2211 Congress St
Portland, ME 04102-1941

5 Perryridge Rd
Greenwich, CT 06830-4641

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
81708CTMDPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Penn-Medical Group CurrentSince Jul 1, 2024 Accepting new patients
University of Penn-Medical Group Current Accepting new patients
University of Penn-Medical Group CurrentSince Jul 1, 2024 Accepting new patients

Locations

3400 Civic Center Blvd
Fl 3
Philadelphia, PA 19104
Phone (215) 614-4100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756252800000",
    "number": "1265995088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 MASON ST",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068302607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 MASON ST",
            "city": "GREENWICH",
            "state": "CT",
            "postal_code": "068302607",
            "telephone_number": "203-661-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOMORONY",
        "first_name": "ANDRE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-09",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "CT",
            "license": "81708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwich, CT

Sources for this page

Verify at the official NPI Registry.