Provider Demographics
NPI:1134673957
Name:ENDOSCOPY CENTER OF CONNECTICUT ANESTHESIA
Entity type:Organization
Organization Name:ENDOSCOPY CENTER OF CONNECTICUT ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:KOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-281-5100
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:203-287-2921
Practice Address - Street 1:2200 WHITNEY AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3691
Practice Address - Country:US
Practice Address - Phone:203-281-3636
Practice Address - Fax:203-287-2921
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENDOSCOPY CENTER OF CONNECTICUT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty