Healthcare Provider Details

I. General information

NPI: 1811128283
Provider Name (Legal Business Name): RADIOLOGY OF GREATER NEW HAVEN LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE.
HAMDEN CT
06517
US

IV. Provider business mailing address

1952 WHITNEY AVE.
HAMDEN CT
06517
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax: 203-848-1777
Mailing address:
  • Phone: 203-848-1803
  • Fax: 203-848-1777

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: MARGARET CHUSTECKA
Title or Position: MD
Credential: MD
Phone: 203-848-1803