Healthcare Provider Details

I. General information

NPI: 1871542316
Provider Name (Legal Business Name): UNIVERSITY STANDING OPEN MRI OF NEW HAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CROWN ST
NEW HAVEN CT
06510-2705
US

IV. Provider business mailing address

216 CROWN ST
NEW HAVEN CT
06510-2705
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-2220
  • Fax: 203-776-2201
Mailing address:
  • Phone: 203-776-2220
  • Fax: 203-776-2201

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: MS. TINA DIJULIO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 610-660-6161