Provider Demographics
NPI:1881802205
Name:EASTERN CONNECTICUT GASTROENTEROLOGY,LLC
Entity type:Organization
Organization Name:EASTERN CONNECTICUT GASTROENTEROLOGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:SALWOCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-875-6944
Mailing Address - Street 1:460 HARTFORD TPKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4819
Mailing Address - Country:US
Mailing Address - Phone:860-875-6944
Mailing Address - Fax:860-871-7857
Practice Address - Street 1:460 HARTFORD TPKE
Practice Address - Street 2:SUITE B
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4819
Practice Address - Country:US
Practice Address - Phone:860-875-6944
Practice Address - Fax:860-871-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037938207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTH84599Medicare UPIN