Provider Demographics
NPI:1033399035
Name:DRS HEALY, MACINSKI, RAO, WADE & GORDON PC
Entity Type:Organization
Organization Name:DRS HEALY, MACINSKI, RAO, WADE & GORDON PC
Other - Org Name:HEALY, MACINSKI, RAO, & WADE MDS, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-522-3711
Mailing Address - Street 1:99 EAST RIVER DR
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:860-282-4133
Mailing Address - Fax:860-289-0742
Practice Address - Street 1:1000 ASYLUM AVE
Practice Address - Street 2:SUITE 4301
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-522-3711
Practice Address - Fax:860-493-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0085492084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00156Medicare PIN