Provider Demographics
NPI:1841487055
Name:CONNECTICUT VALLEY GENERAL & VASCULAR SURGICAL ASSOC PC
Entity type:Organization
Organization Name:CONNECTICUT VALLEY GENERAL & VASCULAR SURGICAL ASSOC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KARABINIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-741-5619
Mailing Address - Street 1:115 ELM ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3712
Mailing Address - Country:US
Mailing Address - Phone:860-741-5619
Mailing Address - Fax:860-741-6072
Practice Address - Street 1:115 ELM ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3712
Practice Address - Country:US
Practice Address - Phone:860-741-5619
Practice Address - Fax:860-741-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0316452086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC01931OtherMEDICARE GROUP #