Healthcare Provider Details

I. General information

NPI: 1144738832
Provider Name (Legal Business Name): HEART CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 STILLWATER AVE. UNIT B
STAMFORD CT
06902-4807
US

IV. Provider business mailing address

215 STILLWATER AVE. UNIT B
STAMFORD CT
06902-4807
US

V. Phone/Fax

Practice location:
  • Phone: 203-674-1810
  • Fax: 203-674-1805
Mailing address:
  • Phone: 203-674-1810
  • Fax: 203-674-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateCT

VIII. Authorized Official

Name: JEFFREY A. GREEN
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 203-674-1810