Provider Demographics
NPI:1073817656
Name:GASTROENTEROLOGY HEPATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:GASTROENTEROLOGY HEPATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITHLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-348-5355
Mailing Address - Street 1:32 STRAWBERRY HILL COURT
Mailing Address - Street 2:SUITE 41042 TULLY HEALTH CENTER
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-348-5355
Mailing Address - Fax:203-348-4082
Practice Address - Street 1:32 STRAWBERRY HILL CT
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-883-9437
Practice Address - Fax:203-348-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01294Medicare UPIN