Healthcare Provider Details

I. General information

NPI: 1912175639
Provider Name (Legal Business Name): PROHEALTH PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

IV. Provider business mailing address

4 FARM SPRINGS RD
FARMINGTON CT
06032-2573
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILIP M PIN
Title or Position: SR. VP & CEO
Credential:
Phone: 860-284-5200