Provider Demographics
NPI:1093138828
Name:CONNECTICUT WOMENS IMAGING
Entity Type:Organization
Organization Name:CONNECTICUT WOMENS IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-739-7532
Mailing Address - Street 1:105 NEWTOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4194
Mailing Address - Country:US
Mailing Address - Phone:203-791-9011
Mailing Address - Fax:
Practice Address - Street 1:105 NEWTOWN RD STE C
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4194
Practice Address - Country:US
Practice Address - Phone:203-791-9011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANBURY RADIOLOGICAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1639164106261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology