PROSPECT DIAGNOSTIC IMAGING; NPI #1154343739

Contact Information

PROSPECT DIAGNOSTIC IMAGING

166 WATERBURY ROAD
RTE 69
PROSPECT, CT 06712

Phone: 203-758-7700
Fax:
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Radiology	261QR0200X	74	Radiation Therapy Center
Magnetic Resonance Imaging (MRI)	261QM1200X

Indicates primary specialty

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NPI Profile & details for PROSPECT DIAGNOSTIC IMAGING

NPI # 1154343739

LBN Legal business name PROSPECT DIAGNOSTIC IMAGING

Authorized official ROBERT GUMBARDO - (MEDICAL DIRECTOR)

Entity Organization

Organization subpart ¹ Yes

Enumeration date 07/24/2006

Last updated 06/06/2013 - About 13 years ago

Identifiers

Medicaid

004221363

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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