1265402416 NPI number — COLON ANDRECTAL SURGEONS OF FAIRFIELD COUNTY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265402416 NPI number — COLON ANDRECTAL SURGEONS OF FAIRFIELD COUNTY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON ANDRECTAL SURGEONS OF FAIRFIELD COUNTY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265402416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2660 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06606-5369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-331-8700
Provider Business Mailing Address Fax Number:
203-335-5819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2660 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06606-5369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-331-8700
Provider Business Practice Location Address Fax Number:
203-335-5819
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PICCIOLI
Authorized Official First Name:
LISA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
203-331-8700

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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