Healthcare Provider Details

I. General information

NPI: 1821081894
Provider Name (Legal Business Name): NEW HAVEN RADIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 CHAPEL ST
NEW HAVEN CT
06511-4405
US

IV. Provider business mailing address

11 LUNAR DR
WOODBRIDGE CT
06525-2320
US

V. Phone/Fax

Practice location:
  • Phone: 203-789-3124
  • Fax: 203-789-4118
Mailing address:
  • Phone: 203-298-9091
  • Fax: 203-298-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK A PINTO JR.
Title or Position: CONTROLLER
Credential:
Phone: 203-298-9091