Healthcare Provider Details

I. General information

NPI: 1689608697
Provider Name (Legal Business Name): ADVANCED COLON CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 BOSTON POST RD SUITE 1
OLD SAYBROOK CT
06475-2143
US

IV. Provider business mailing address

929 BOSTON POST RD SUITE 1
OLD SAYBROOK CT
06475-2143
US

V. Phone/Fax

Practice location:
  • Phone: 860-395-0554
  • Fax: 860-395-0448
Mailing address:
  • Phone: 860-395-0554
  • Fax: 860-395-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MAURIZIO DOMENICO NICHELE
Title or Position: PRESIDENT
Credential:
Phone: 860-395-0554