Provider Demographics
NPI:1295720670
Name:ENDOCRINE ASSOCIATES LLC
Entity type:Organization
Organization Name:ENDOCRINE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-372-7200
Mailing Address - Street 1:115 TECHNOLOGY DR UNIT C101
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6300
Mailing Address - Country:US
Mailing Address - Phone:203-372-7200
Mailing Address - Fax:203-374-1473
Practice Address - Street 1:115 TECHNOLOGY DR UNIT C101
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6300
Practice Address - Country:US
Practice Address - Phone:203-372-7200
Practice Address - Fax:203-374-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004246783Medicaid
CTDC5833OtherMEDICARE RAILROAD GROUP #