Provider Demographics
NPI:1306039060
Name:INVISION MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:INVISION MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-830-7182
Mailing Address - Street 1:19 BUCKINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2758
Mailing Address - Country:US
Mailing Address - Phone:860-294-6607
Mailing Address - Fax:
Practice Address - Street 1:21 ARCH ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001
Practice Address - Country:US
Practice Address - Phone:860-673-1955
Practice Address - Fax:860-673-8379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2085R0202X
CT0359262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03798Medicare PIN