Provider Demographics
NPI:1003804709
Name:SPECIALTY IMAGING ASSOCIATES, LLC
Entity type:Organization
Organization Name:SPECIALTY IMAGING ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRT
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-426-3002
Mailing Address - Street 1:60 NEWTOWN RD # 45
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6257
Mailing Address - Country:US
Mailing Address - Phone:203-426-3002
Mailing Address - Fax:203-426-6411
Practice Address - Street 1:2 RIVERVIEW DRIVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-426-3002
Practice Address - Fax:203-426-6411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03337Medicare PIN
CTDG3227Medicare PIN