Provider Demographics
NPI:1669461133
Name:NORTHEAST RADIOLOGY OF CONNECTICUT, LLC
Entity Type:Organization
Organization Name:NORTHEAST RADIOLOGY OF CONNECTICUT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:849-278-6200
Mailing Address - Street 1:3839 DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5412
Mailing Address - Country:US
Mailing Address - Phone:845-278-6200
Mailing Address - Fax:845-278-7802
Practice Address - Street 1:73 SAND PIT RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4042
Practice Address - Country:US
Practice Address - Phone:203-798-2003
Practice Address - Fax:203-791-2583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST RADIOLOGY OF CONNECTICUT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-18
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty