Provider Demographics
NPI:1134141716
Name:NAUGATUCK VALLEY MRI LLC
Entity Type:Organization
Organization Name:NAUGATUCK VALLEY MRI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-264-7999
Mailing Address - Street 1:C/O NVRA 385 MAIN ST SOUTH
Mailing Address - Street 2:UNION SQUARE BLG 1
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488
Mailing Address - Country:US
Mailing Address - Phone:203-264-7999
Mailing Address - Fax:203-264-7477
Practice Address - Street 1:1389 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3104
Practice Address - Country:US
Practice Address - Phone:203-574-1311
Practice Address - Fax:203-573-1062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAUGATUCK VALLEY RADIOLOGICAL ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004086858Medicaid
CTC00546Medicare ID - Type Unspecified