Provider Demographics
NPI:1730154196
Name:ANESTHESIOLOGY ASSOCIATES OF EASTERN CONNECTICUT, P.C
Entity type:Organization
Organization Name:ANESTHESIOLOGY ASSOCIATES OF EASTERN CONNECTICUT, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KWOK
Authorized Official - Middle Name:ON
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-649-1550
Mailing Address - Street 1:953 MAIN ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-6014
Mailing Address - Country:US
Mailing Address - Phone:860-649-1550
Mailing Address - Fax:860-649-1091
Practice Address - Street 1:71 HAYNES ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4131
Practice Address - Country:US
Practice Address - Phone:860-649-1550
Practice Address - Fax:860-649-1091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT=========OtherEIN
CT=========OtherEIN