Healthcare Provider Details

I. General information

NPI: 1407159833
Provider Name (Legal Business Name): CARDIOLOGY ASSOCIATES OF GREATER WATERBURY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2010
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CHASE PKWY
WATERBURY CT
06708
US

IV. Provider business mailing address

455 CHASE PKWY
WATERBURY CT
06708-3352
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 State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS L DOBKIN
Title or Position: BOARD MEMBER OF PHYSICIAN COUNCIL
Credential: MD
Phone: 203-573-1435