Provider Demographics
NPI:1124131636
Name:CENTRAL CONNECTICUT ENDOSCOPY CENTER
Entity type:Organization
Organization Name:CENTRAL CONNECTICUT ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEAGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-793-8500
Mailing Address - Street 1:440 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2016
Mailing Address - Country:US
Mailing Address - Phone:860-793-8500
Mailing Address - Fax:860-747-4873
Practice Address - Street 1:440 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-2016
Practice Address - Country:US
Practice Address - Phone:860-793-8500
Practice Address - Fax:860-747-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0291261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy