Provider Demographics
NPI:1508043613
Name:HOUSATONIC VALLEY RADIOLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:HOUSATONIC VALLEY RADIOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:P
Authorized Official - Last Name:EHRLICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-797-1770
Mailing Address - Street 1:67 SAND PIT RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4032
Mailing Address - Country:US
Mailing Address - Phone:203-797-1770
Mailing Address - Fax:203-796-7839
Practice Address - Street 1:67 SAND PIT RD
Practice Address - Street 2:SUITE 105
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4032
Practice Address - Country:US
Practice Address - Phone:203-797-1770
Practice Address - Fax:203-796-7839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT630000011Medicare PIN