Healthcare Provider Details

I. General information

NPI: 1407141328
Provider Name (Legal Business Name): GABRIELA ZAGARODNE SPILBERG MISSINE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA SPILBERG MD

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

15 LEDYARD RD
WEST HARTFORD CT
06117-1712
US

V. Phone/Fax

Practice location:
  • Phone: 203-605-9993
  • Fax:
Mailing address:
  • Phone: 617-775-4464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number249237
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number66162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: