Healthcare Provider Details

I. General information

NPI: 1548175748
Provider Name (Legal Business Name): CONNECTICUT BREAST IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 FEDERAL RD
BROOKFIELD CT
06804-2028
US

IV. Provider business mailing address

730 FEDERAL RD
BROOKFIELD CT
06804-2028
US

V. Phone/Fax

Practice location:
  • Phone: 203-791-9011
  • Fax: 203-917-3373
Mailing address:
  • Phone:
  • 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: KIRT FREDERICKSON
Title or Position: PRESIDENT
Credential: MD
Phone: 203-426-3002