Healthcare Provider Details

I. General information

NPI: 1801322912
Provider Name (Legal Business Name): CARDIOLOGY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

V. Phone/Fax

Practice location:
  • Phone: 203-773-3055
  • Fax: 203-281-5796
Mailing address:
  • Phone: 203-773-3055
  • Fax: 203-281-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number31413
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28963
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18630
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number38397
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1672
License Number StateCT
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number33597
License Number StateCT

VIII. Authorized Official

Name: DR. JONATHAN A BRIER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-773-3055