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General NPI Number Information
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NPI Number | 1295976397
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Entity Type | Organization
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Legal Business Name | CT.GASTROENTEROLOGY ASSOC. PC
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 1000 ASYLUM AVE SUITE 3212
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City | HARTFORD
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State | CT
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Zip | 06105-1770
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Country | US
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Telephone | 860-522-1171
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Fax | 860-493-6524
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Provider Business Mailing Address
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Address Line | 1000 ASYLUM AVE SUITE 3212
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City | HARTFORD
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State | CT
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Zip | 06105-1770
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Country | US
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Telephone | 860-522-1171
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Fax | 860-493-6524
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN POLIO
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Credential | M.D.
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Telephone | 860-522-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 001824
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License Number State | CT
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