Canton Geriatrics PLLC

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

CANTON GERIATRICS PLLC

Practice address

461 Cherry Brook Road
Canton, CT 06019

Phone

(845) 527-8854

NPI assigned

Mar 10, 2020

Last updated

Mar 10, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tina Marie Gardner, M.D.NPI 1629050281

Title

Physician/Owner

Phone

(845) 527-8854

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tina Marie Gardner, MD

  • Family Medicine Physician
  • Norwalk, CT
  • NPI 1629050281
  NPD Authorized official

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1912532953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "461 CHERRY BROOK ROAD",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "06019",
            "telephone_number": "845-527-8854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "461 CHERRY BROOK ROAD",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "06019",
            "telephone_number": "845-527-8854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANTON GERIATRICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "845-527-8854",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Wooldridge Breton, APRN
• Rebecca Desautels Brickman
• Ian Brokaw, DPT
• Carolyn Brown, OTD, OTR/L
• Jennifer Cannon, APRN
• Canton Interventional Radiologist Group PC
• Canton Physical Therapy, LLC
• Canton Valley Dental LLC
• Carolyn Brown Otd Mobile Therapy, LLC
• Jo-Ann Castellone, D.M.D.

• Health Service Clinic/Center in Canton, CT
• Providers in Canton, CT by specialty
• Health Service Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.