Healthcare Provider Details

I. General information

NPI: 1477695104
Provider Name (Legal Business Name): SURGICAL ASSOCIATES OF CONNECTICUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 MAIN ST SUITE 110
BRIDGEPORT CT
06606-5369
US

IV. Provider business mailing address

2660 MAIN ST SUITE 110
BRIDGEPORT CT
06606-5369
US

V. Phone/Fax

Practice location:
  • Phone: 203-332-4744
  • Fax:
Mailing address:
  • Phone: 203-332-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number030627
License Number StateCT

VIII. Authorized Official

Name: DR. ANTHY DEMESTIHAS
Title or Position: PRESIDENT
Credential: MD
Phone: 203-332-4744