Provider Demographics
NPI:1033318175
Name:SOUTHERN CONNECTICUT VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:SOUTHERN CONNECTICUT VASCULAR CENTER, LLC
Other - Org Name:THE VASCULAR EXPERTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HURIBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-375-2861
Mailing Address - Street 1:6 RESEARCH DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6228
Mailing Address - Country:US
Mailing Address - Phone:203-210-6340
Mailing Address - Fax:203-502-2615
Practice Address - Street 1:495 HAWLEY LN STE 2A
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-1597
Practice Address - Country:US
Practice Address - Phone:844-974-4122
Practice Address - Fax:203-502-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02848Medicare PIN