| Windham Gi, Llc | |
|
150 Mansfield Ave Willimantic CT 06226-2026 | |
| (860) 423-3299 | |
| (860) 423-8739 |
| Full Name | Windham Gi, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 150 Mansfield Ave, Willimantic, Connecticut |
| Authorized Official Name and Position | Ajit Kokkat (PHYSICIAN) |
| Authorized Official Contact | 8604233299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Windham Gi, Llc 150 Mansfield Ave Willimantic CT 06226-2026 Ph: (860) 423-3299 | Windham Gi, Llc 150 Mansfield Ave Willimantic CT 06226-2026 Ph: (860) 423-3299 |
| NPI Number | 1174908289 |
|---|---|
| Provider Enumeration Date | 07/30/2015 |
| Last Update Date | 07/30/2015 |
| Medicare PECOS PAC ID | 5092023655 |
|---|---|
| Medicare Enrollment ID | O20150930002335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174908289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 43541 (Connecticut) | Primary |
| Provider Name | Ajit Kokkat |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1962438143 PECOS PAC ID: 5395761084 Enrollment ID: I20051021000425 |
| Provider Name | Kristina M Amato |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750699369 PECOS PAC ID: 7618165804 Enrollment ID: I20110104000140 |
| Provider Name | Nicole Monahan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992161558 PECOS PAC ID: 8123323219 Enrollment ID: I20160229000076 |
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