Healthcare Provider Details

I. General information

NPI: 1881721900
Provider Name (Legal Business Name): NAUGATUCK VALLEY CARDIOVASCULAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STRAITS TPKE SUITE 209
MIDDLEBURY CT
06762-1836
US

IV. Provider business mailing address

1625 STRAITS TPKE SUITE 209
MIDDLEBURY CT
06762-1836
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-9100
  • Fax:
Mailing address:
  • Phone: 203-758-9100
  • Fax: 203-758-9400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6868
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE ANTONOPOULOS
Title or Position: OWNER
Credential: MD
Phone: 203-758-9100