=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316142839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY CENTER OF NEW ENGLAND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2007
-----------------------------------------------------
Last Update Date | 07/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 245 AMITY RD SUITE 206
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-495-8844
-----------------------------------------------------
Fax | 203-495-9068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 245 AMITY RD SUITE 206
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06525-2258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-495-8844
-----------------------------------------------------
Fax | 203-495-9068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN OWNER
-----------------------------------------------------
Name | DR. HOWARD MITCHELL LIKIER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-495-8844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 031648
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------