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General NPI Number Information
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NPI Number | 1730148784
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Entity Type | Organization
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Legal Business Name | CONNECTICUT IMAGE GUIDED SURGERY, PC
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Dates
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Enumeration Date | 03/20/2006
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 1152 KINGS HIGHWAY CUTOFF STE 104
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City | FAIRFIELD
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State | CT
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Zip | 06824-5273
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Country | US
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Telephone | 203-330-0248
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Fax | 203-330-9730
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Provider Business Mailing Address
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Address Line | PO BOX 416139
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City | BOSTON
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State | MA
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Zip | 02241-6139
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Country | US
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Telephone | 610-644-8900
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Fax | 484-924-0053
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | GREGG MILLER
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Credential | M.D.
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Telephone | 717-515-4048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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