Provider Demographics
NPI:1326131418
Name:ENDOSCOPY CENTER OF CONNECTICUT, LLC
Entity Type:Organization
Organization Name:ENDOSCOPY CENTER OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-281-3636
Mailing Address - Street 1:2200 WHITNEY AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3691
Mailing Address - Country:US
Mailing Address - Phone:203-281-3636
Mailing Address - Fax:203-287-2934
Practice Address - Street 1:1591 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4335
Practice Address - Country:US
Practice Address - Phone:203-281-3636
Practice Address - Fax:203-287-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy