=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073817656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY HEPATOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2010
-----------------------------------------------------
Last Update Date | 03/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 STRAWBERRY HILL CT
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902-2594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-883-9437
-----------------------------------------------------
Fax | 203-348-3445
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 STRAWBERRY HILL COURT SUITE 41042 TULLY HEALTH CENTER
-----------------------------------------------------
City | STAMFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-348-5355
-----------------------------------------------------
Fax | 203-348-4082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCOUNT MANAGER
-----------------------------------------------------
Name | DR. AMY E SMITHLINE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-348-5355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------