Provider Demographics
NPI:1952495087
Name:GENERAL SURGICAL ASSOCIATES OF N.L., P.C.
Entity Type:Organization
Organization Name:GENERAL SURGICAL ASSOCIATES OF N.L., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-443-3147
Mailing Address - Street 1:50 FAIR HARBOUR PL
Mailing Address - Street 2:SUITE 2-C
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4731
Mailing Address - Country:US
Mailing Address - Phone:860-443-3147
Mailing Address - Fax:860-443-0087
Practice Address - Street 1:50 FAIR HARBOUR PL
Practice Address - Street 2:SUITE 2-C
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4731
Practice Address - Country:US
Practice Address - Phone:860-443-3147
Practice Address - Fax:860-443-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004394558Medicaid
CTC14779OtherRAILROAD MEDICARE
CTC01306Medicare PIN