1306039060 NPI number — INVISION MEDICAL IMAGING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306039060 NPI number — INVISION MEDICAL IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INVISION MEDICAL IMAGING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306039060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 BUCKINGHAM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06117-2758
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-294-6607
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21 ARCH ROAD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-673-1955
Provider Business Practice Location Address Fax Number:
860-673-8379
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GERSHON
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD PHYSICIAN
Authorized Official Telephone Number:
860-830-7182

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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