Provider Demographics
NPI:1003837907
Name:CENTER FOR GASTROINTESTINAL MEDICINE OF FAIRFIELD & WESTCHESTER, P.C.
Entity Type:Organization
Organization Name:CENTER FOR GASTROINTESTINAL MEDICINE OF FAIRFIELD & WESTCHESTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-863-2907
Mailing Address - Street 1:500 W PUTNAM AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6086
Mailing Address - Country:US
Mailing Address - Phone:203-863-2900
Mailing Address - Fax:203-863-2901
Practice Address - Street 1:500 W PUTNAM AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6086
Practice Address - Country:US
Practice Address - Phone:203-863-2900
Practice Address - Fax:203-863-2901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4049557Medicaid
CT4049557Medicaid
CT=========OtherBLUE CROSS BLUE SHIELD
CT4049557Medicaid