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General NPI Number Information
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NPI Number | 1689429078
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Entity Type | Organization
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Legal Business Name | ADVANCED IMAGING SPECIALISTS, LLC
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 114 WOODLAND ST
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City | HARTFORD
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State | CT
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Zip | 06105-1208
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Country | US
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Telephone | 203-426-3002
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Fax |
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Provider Business Mailing Address
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Address Line | 2 RIVERVIEW DR STE 104
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City | DANBURY
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State | CT
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Zip | 06810-6268
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Country | US
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Telephone | 203-426-3002
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Fax | 203-917-3373
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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 | MD
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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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