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General NPI Number Information
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NPI Number | 1245295401
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Entity Type | Organization
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Legal Business Name | GREATER WATERBURY IMAGING CENTER LIMITED PARTNERSHIP
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 68 ROBBINS ST
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City | WATERBURY
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State | CT
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Zip | 06708-2613
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Country | US
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Telephone | 203-573-7674
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Fax | 203-573-6255
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Provider Business Mailing Address
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Address Line | PO BOX 150473 DEPT. 335
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City | HARTFORD
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State | CT
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Zip | 06115-0473
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Country | US
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Telephone | 949-282-6000
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. KEITH S. KELSON
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Credential |
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Telephone | 949-282-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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