Provider Demographics
NPI:1255820544
Name:WALLINGFORD ENDOSCOPY CENTER, LLC.
Entity type:Organization
Organization Name:WALLINGFORD ENDOSCOPY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:NESTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-309-6096
Mailing Address - Street 1:863 N MAIN STREET EXT STE 300
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2434
Mailing Address - Country:US
Mailing Address - Phone:203-309-6096
Mailing Address - Fax:
Practice Address - Street 1:863 N MAIN STREET EXT STE 300
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2434
Practice Address - Country:US
Practice Address - Phone:714-766-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy