Healthcare Provider Details

I. General information

NPI: 1578838405
Provider Name (Legal Business Name): RIVERSIDE RADIOLOGY CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2012
Last Update Date: 03/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HARVARD AVE
STAMFORD CT
06902-5564
US

IV. Provider business mailing address

PO BOX 698
RIVERSIDE CT
06878-0698
US

V. Phone/Fax

Practice location:
  • Phone: 203-912-4574
  • Fax:
Mailing address:
  • Phone: 203-912-4574
  • Fax: 203-724-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC HAMET
Title or Position: CEO
Credential: MD
Phone: 203-912-4574