# DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972758183
- **Authorized official:** CHRISTOPHER DUNBAR ILLICK (PARTNER)
- **Authorized official phone:** (203) 481-0315

## Contact information

- **Practice address:** 687 MAIN ST, BRANFORD, CT 06405-3612
- **Practice address phone:** (203) 481-0315
- **Practice address fax:** (203) 488-6945
- **Mailing address:** 687 MAIN ST, BRANFORD, CT 06405-3612
- **Mailing address phone:** (203) 481-0315
- **Mailing address fax:** (203) 488-6945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0322 | CT | Yes |

## Other

- **Enumeration date:** 12/02/2008
- **Last updated:** 03/04/2022