Healthcare Provider Details

I. General information

NPI: 1043232622
Provider Name (Legal Business Name): NAUGATUCK DIAGNOSTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CHURCH STREET
NAUGATUCK CT
06770
US

IV. Provider business mailing address

385 MAIN ST S NVRA UNION SQUARE BLDG #1
SOUTHBURY CT
06488
US

V. Phone/Fax

Practice location:
  • Phone: 203-729-2215
  • Fax:
Mailing address:
  • Phone: 203-264-7999
  • Fax: 203-264-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GUMBARDO
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 203-264-7999