Healthcare Provider Details

I. General information

NPI: 1023471273
Provider Name (Legal Business Name): BRENDAN GONTARZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 STATE ST
NORTH HAVEN CT
06473-6103
US

IV. Provider business mailing address

280 STATE ST
NORTH HAVEN CT
06473-6103
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-2886
  • Fax: 203-288-2576
Mailing address:
  • Phone: 203-288-2886
  • Fax: 203-288-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number75034
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: