Healthcare Provider Details

I. General information

NPI: 1083368955
Provider Name (Legal Business Name): HVRA OF NEW MILFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2022
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 OLD NEW MILFORD RD STE 2A
BROOKFIELD CT
06804-2434
US

IV. Provider business mailing address

18201 VON KARMAN AVE STE 600
IRVINE CA
92612-1176
US

V. Phone/Fax

Practice location:
  • Phone: 203-780-7012
  • Fax:
Mailing address:
  • Phone: 949-242-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HOWARD LEE
Title or Position: PRESIDENT
Credential:
Phone: 845-278-6200