Healthcare Provider Details

I. General information

NPI: 1386637742
Provider Name (Legal Business Name): SAINT RAPHAEL MR CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 02/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ORCHARD ST
NEW HAVEN CT
06511-4417
US

IV. Provider business mailing address

11 LUNAR DR
WOODBRIDGE CT
06525-2320
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-4120
  • Fax: 203-789-5183
Mailing address:
  • Phone: 203-298-9113
  • Fax: 203-298-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ZENON PROTOPAPAS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 203-789-4120