Healthcare Provider Details

I. General information

NPI: 1295856714
Provider Name (Legal Business Name): LUNG ASSOCIATES OF CONNECTICUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 PRINCE ST
NEW HAVEN CT
06519-1600
US

IV. Provider business mailing address

46 PRINCE ST
NEW HAVEN CT
06519-1600
US

V. Phone/Fax

Practice location:
  • Phone: 203-923-7013
  • Fax: 203-502-0119
Mailing address:
  • Phone: 203-923-7013
  • Fax: 203-502-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL IMEVBORE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 203-923-7013