Provider Demographics
NPI:1578986055
Name:STAMFORD GASTROENTEROLOGY, INC
Entity Type:Organization
Organization Name:STAMFORD GASTROENTEROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEGBENEBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-998-7400
Mailing Address - Street 1:19 HIGH RIDGE RD
Mailing Address - Street 2:3617
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-7801
Mailing Address - Country:US
Mailing Address - Phone:203-998-7400
Mailing Address - Fax:
Practice Address - Street 1:90 MORGAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5406
Practice Address - Country:US
Practice Address - Phone:203-998-7400
Practice Address - Fax:203-358-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043139207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891728853OtherNPI
CTI36545Medicare UPIN