Healthcare Provider Details

I. General information

NPI: 1386757854
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF CONNECTICUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 WHITNEY AVE SUITE 380
HAMDEN CT
06518-3691
US

IV. Provider business mailing address

2200 WHITNEY AVE STE 380
HAMDEN CT
06518-3602
US

V. Phone/Fax

Practice location:
  • Phone: 203-281-3636
  • Fax: 203-287-2934
Mailing address:
  • Phone: 203-281-3636
  • Fax: 203-287-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number0279
License Number StateCT

VIII. Authorized Official

Name: DR. DEAN CHANG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 203-281-3636