Provider Demographics
NPI:1528208121
Name:CARDIOVASCULAR SPECIALISTS OF SOUTHBURY LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR SPECIALISTS OF SOUTHBURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-264-5911
Mailing Address - Street 1:30 QUAKER FARMS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2732
Mailing Address - Country:US
Mailing Address - Phone:203-264-5911
Mailing Address - Fax:203-264-9177
Practice Address - Street 1:30 QUAKER FARMS RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2732
Practice Address - Country:US
Practice Address - Phone:203-264-5911
Practice Address - Fax:203-264-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25203207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060000345OtherMEDICARE GROUP #
CTB83785Medicare UPIN