Provider Demographics
NPI:1093910945
Name:CARDIOVASCULAR HEALTH, LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-624-6028
Mailing Address - Street 1:2 CHURCH ST S
Mailing Address - Street 2:SUITE 412
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1717
Mailing Address - Country:US
Mailing Address - Phone:203-624-6028
Mailing Address - Fax:203-562-9576
Practice Address - Street 1:2 CHURCH ST S
Practice Address - Street 2:SUITE 412
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1717
Practice Address - Country:US
Practice Address - Phone:203-624-6028
Practice Address - Fax:203-562-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03782Medicare PIN