Healthcare Provider Details

I. General information

NPI: 1356392930
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES OF WATERBURY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CHASE PKWY
WATERBURY CT
06708-3303
US

IV. Provider business mailing address

455 CHASE PKWY
WATERBURY CT
06708-3303
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-1435
  • Fax: 203-755-7433
Mailing address:
  • Phone: 203-573-1435
  • Fax: 203-755-7433

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 Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateCT

VIII. Authorized Official

Name: DR. DENNIS L DOBKIN
Title or Position: VICE-PRESIDENT
Credential: MD
Phone: 203-573-1435