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General NPI Number Information
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NPI Number | 1003804709
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Entity Type | Organization
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Legal Business Name | SPECIALTY IMAGING ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2 RIVERVIEW DRIVE SUITE 104
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone | 203-426-3002
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Fax | 203-426-6411
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Provider Business Mailing Address
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Address Line | 60 NEWTOWN RD # 45
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City | DANBURY
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State | CT
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Zip | 06810-6257
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Country | US
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Telephone | 203-426-3002
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Fax | 203-426-6411
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIRT FREDERICKSON
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Credential |
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Telephone | 203-426-3002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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