Healthcare Provider Details

I. General information

NPI: 1043283906
Provider Name (Legal Business Name): NAUGATUCK VALLEY ENDOSCOPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 WEST MAIN ST
WATERBURY CT
06708
US

IV. Provider business mailing address

1312 WEST MAIN ST
WATERBURY CT
06708
US

V. Phone/Fax

Practice location:
  • Phone: 203-756-6422
  • Fax: 203-756-2448
Mailing address:
  • Phone: 203-756-6422
  • Fax: 203-756-2448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number0284
License Number StateCT

VIII. Authorized Official

Name: DIANE YOUD
Title or Position: ADMINISTRATOR
Credential:
Phone: 203-346-2207