Organization
CONNECTICUT IMAGING PARTNERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWNEE MOODY (CREDENTIALING COORDINATOR)
(860) 289-3375
Entity
Organization
Contact information
Practice address
100 HAZARD AVE, ENFIELD, CT 06082-5446
(860) 283-3375
(860) 783-5733
Mailing address
111 FOUNDERS PLZ, SUITE 400 - CREDENTIALING, EAST HARTFORD, CT 06108-3212
(860) 289-3375
(860) 783-5733
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004252110
—
CT
Enumeration date
07/16/2010
Last updated
12/21/2010
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