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General NPI Number Information
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NPI Number | 1023120326
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY CENTER OF CONNECTICUT, PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/08/2013
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Provider Practice Location Address
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Address Line | 2200 WHITNEY AVE SUITE 360
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City | HAMDEN
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State | CT
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Zip | 06518-3691
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Country | US
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Telephone | 203-281-4463
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Fax | 203-287-2914
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Provider Business Mailing Address
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Address Line | 2200 WHITNEY AVE SUITE 360
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City | HAMDEN
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State | CT
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Zip | 06518-3691
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Country | US
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Telephone | 203-281-4463
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Fax | 203-287-2914
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. PHILIP JAFFE
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Credential | MD
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Telephone | 203-281-4463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 040315
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License Number State | CT
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