Provider Demographics
NPI:1356544746
Name:SOUTHEASTERN CONNECTICUT IMAGING CENTER, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN CONNECTICUT IMAGING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-442-8800
Mailing Address - Street 1:196 WATERFORD PARKWAY
Mailing Address - Street 2:#102
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-442-8800
Mailing Address - Fax:860-442-8900
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:102
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-442-8800
Practice Address - Fax:860-442-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology