Healthcare Provider Details

I. General information

NPI: 1487840096
Provider Name (Legal Business Name): CENTER FOR DIGESTIVE DISEASES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HOSPITAL AVENUE
DANBURY CT
06810
US

IV. Provider business mailing address

2 HOSPITAL AVENUE
DANBURY CT
06810
US

V. Phone/Fax

Practice location:
  • Phone: 203-790-9551
  • Fax: 203-778-9961
Mailing address:
  • Phone: 203-790-9551
  • Fax: 203-778-9961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30351
License Number StateCT

VIII. Authorized Official

Name: DAVID BARENBERG
Title or Position: OWNER
Credential: MD
Phone: 203-790-9551