Provider Demographics
NPI:1487677951
Name:MIDSTATE GASTROENTEROLOGY SPECIALISTS PC
Entity Type:Organization
Organization Name:MIDSTATE GASTROENTEROLOGY SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-237-2477
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-237-2477
Mailing Address - Fax:203-238-1839
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-237-2477
Practice Address - Fax:203-238-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027392207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty