Healthcare Provider Details

I. General information

NPI: 1528240108
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF MANCHESTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 TOLLAND TPKE SUITE 2C
MANCHESTER CT
06042-1771
US

IV. Provider business mailing address

360 TOLLAND TURNPIKE SUITE 2C
MANCHESTER CT
06040
US

V. Phone/Fax

Practice location:
  • Phone: 860-643-8000
  • Fax: 860-647-7124
Mailing address:
  • Phone: 860-643-8000
  • Fax: 860-647-7124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number003443
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number021190
License Number StateCT

VIII. Authorized Official

Name: DR. ROBERT GARY SCHWARTZ
Title or Position: OWNER
Credential: M.D.
Phone: 860-643-8000