Provider Demographics
NPI:1598100869
Name:SEABRIGHT CARDIOVASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:SEABRIGHT CARDIOVASCULAR CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KLEOMANES
Authorized Official - Middle Name:C
Authorized Official - Last Name:KATSETOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-243-6015
Mailing Address - Street 1:353 BRIDGEPORT AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-243-6015
Mailing Address - Fax:860-308-2095
Practice Address - Street 1:353 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-243-6015
Practice Address - Fax:860-308-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI59227Medicare UPIN