Organization
DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DUNBAR ILLICK (PARTNER)
(203) 481-0315
Entity
Organization
Contact information
Practice address
687 MAIN ST, BRANFORD, CT 06405-3612
(203) 481-0315
(203) 488-6945
Mailing address
687 MAIN ST, BRANFORD, CT 06405-3612
(203) 481-0315
(203) 488-6945
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0322
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07C0001054
CCN CENTERS FOR MEDICARE AND MEDICAID SERVICES CERTIFICATION NUMBER
CT
Enumeration date
12/02/2008
Last updated
03/04/2022
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