Healthcare Provider Details
I. General information
NPI: 1023124625
Provider Name (Legal Business Name): CONNECTICUT GI PLLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/23/2006
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
85 SEYMOUR ST 1000
HARTFORD CT
06106-5501
US
IV. Provider business mailing address
30 WATERCHASE DR
ROCKY HILL CT
06067-2110
US
V. Phone/Fax
- Phone: 860-246-2571
- Fax: 860-246-3691
- Phone: 860-257-4131
- Fax: 860-257-4519
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 133V00000X |
| Taxonomy | Registered Dietitian |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207ZP0102X |
| Taxonomy | Anatomic Pathology & Clinical Pathology Physician |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | CT |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | |
| License Number State | CT |
| # 6 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
JEFFREY
L
NESTLER
Title or Position: PRESIDENT
Credential: MD
Phone: 860-246-2571