Provider Demographics
NPI:1144350141
Name:NAUGATUCK VALLEY GASTROENTEROLOGY CONSULTANTS LLC
Entity type:Organization
Organization Name:NAUGATUCK VALLEY GASTROENTEROLOGY CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-756-6422
Mailing Address - Street 1:1312 W MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3121
Mailing Address - Country:US
Mailing Address - Phone:203-756-6422
Mailing Address - Fax:203-756-2448
Practice Address - Street 1:1312 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3121
Practice Address - Country:US
Practice Address - Phone:203-756-6422
Practice Address - Fax:203-756-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004146777Medicaid
CTCK2200OtherRAILROAD MEDICARE
CTC01904Medicare PIN