Healthcare Provider Details

I. General information

NPI: 1902096324
Provider Name (Legal Business Name): HOUSATONIC VALLEY RADIOLOGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SAND PIT RD SUITE 105
DANBURY CT
06810-4032
US

IV. Provider business mailing address

67 SAND PIT RD
DANBURY CT
06810-4032
US

V. Phone/Fax

Practice location:
  • Phone: 203-797-1770
  • Fax: 203-796-7839
Mailing address:
  • Phone: 203-797-1770
  • Fax: 203-796-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CONRAD P EHRLICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-797-1770