Provider Demographics
NPI:1427004563
Name:HEART SPECIALISTS PC OF SOUTHERN CONNECTICUT
Entity Type:Organization
Organization Name:HEART SPECIALISTS PC OF SOUTHERN CONNECTICUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DSOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-929-9799
Mailing Address - Street 1:4 CORPORATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6211
Mailing Address - Country:US
Mailing Address - Phone:203-929-9799
Mailing Address - Fax:203-925-8264
Practice Address - Street 1:4 CORPORATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6211
Practice Address - Country:US
Practice Address - Phone:203-929-9799
Practice Address - Fax:203-925-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Not Answered207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03090Medicare ID - Type Unspecified