Provider Demographics
NPI:1477695104
Name:SURGICAL ASSOCIATES OF CONNECTICUT
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMESTIHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-332-4744
Mailing Address - Street 1:2660 MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5369
Mailing Address - Country:US
Mailing Address - Phone:203-332-4744
Mailing Address - Fax:
Practice Address - Street 1:2660 MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5369
Practice Address - Country:US
Practice Address - Phone:203-332-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030627208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4133972Medicaid
CTF29019Medicare UPIN
CTB84135Medicare UPIN
CTB38099Medicare UPIN