Provider Demographics
NPI:1316142839
Name:GASTROENTEROLOGY CENTER OF NEW ENGLAND LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY CENTER OF NEW ENGLAND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:LIKIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-495-8844
Mailing Address - Street 1:245 AMITY RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525-2258
Mailing Address - Country:US
Mailing Address - Phone:203-495-8844
Mailing Address - Fax:203-495-9068
Practice Address - Street 1:245 AMITY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525-2258
Practice Address - Country:US
Practice Address - Phone:203-495-8844
Practice Address - Fax:203-495-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT031648OtherCONNECTICARE
CT2904352OtherUNITED HEALTH CARE
CT010031648CT01OtherANTHEM
CT001316480Medicaid
CT2V1274OtherHEALTHNET
CTNHS166OtherOXFORD
CT2727102OtherAETNA
CT0803110002OtherCIGNA
CTAA11990OtherHARVARD PILGRAM
CT001316480Medicaid
CTE44834Medicare UPIN
CT100000343Medicare ID - Type Unspecified