Provider Demographics
NPI:1295839900
Name:VA-CT HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:VA-CT HEALTHCARE SYSTEM
Other - Org Name:OPIOID TREATMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/PSYCHATRYMEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KISHORCHANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GONSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-932-5711
Mailing Address - Street 1:950 CAMPBELL AVE
Mailing Address - Street 2:BULD# 36, MAIL CODE 116 A4
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-2770
Mailing Address - Country:US
Mailing Address - Phone:203-932-5711
Mailing Address - Fax:203-937-3478
Practice Address - Street 1:950 CAMPBELL AVE
Practice Address - Street 2:BULD# 36, MAIL CODE 116 A4
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2770
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:203-937-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036772261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT036772OtherPHYSICIAN