Healthcare Provider Details

I. General information

NPI: 1073621579
Provider Name (Legal Business Name): SHORELINE ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BOSTON POST RD BLDG 1
GUILFORD CT
06437-2770
US

IV. Provider business mailing address

100 CHURCH ST S # MCS-2
NEW HAVEN CT
06519-1703
US

V. Phone/Fax

Practice location:
  • Phone: 203-453-7100
  • Fax: 203-453-7810
Mailing address:
  • Phone: 203-688-2046
  • Fax: 203-688-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0281
License Number StateCT

VIII. Authorized Official

Name: KIMBERLY CLAING
Title or Position: EXEC DIRECTOR, CORP BUS SERVICES
Credential:
Phone: 203-688-2046