Healthcare Provider Details

I. General information

NPI: 1023575800
Provider Name (Legal Business Name): HVRA OF NEW MILFORD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 OLD RIDGEBURY RD STE 103
DANBURY CT
06810-5119
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 203-350-4005
  • Fax: 203-350-4006
Mailing address:
  • Phone: 800-544-3215
  • 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: OWNER
Credential: MD
Phone: 845-278-6200