Provider Demographics
NPI:1801481825
Name:CONNECTICUT GASTROENTEROLOGY ASSOC PC
Entity type:Organization
Organization Name:CONNECTICUT GASTROENTEROLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNUNZIATA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACCARIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-522-1171
Mailing Address - Street 1:1000 ASYLUM AVE STE 3212
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1702
Mailing Address - Country:US
Mailing Address - Phone:860-522-1171
Mailing Address - Fax:860-493-6524
Practice Address - Street 1:18 HAYNES ST STE A
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4111
Practice Address - Country:US
Practice Address - Phone:860-533-0008
Practice Address - Fax:860-533-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty