JEFFERSON RADIOLOGY, PC (NPI# 1720316128) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720316128 |
| Entity Type | Organization |
| Organization Name | JEFFERSON RADIOLOGY, PC |
| Practice Address |
18 E Granby Rd Granby CT 06035-2201 |
| Mailing Address |
111 Founders Plz Suite 400 East Hartford CT 06108-3212 |
| Practice Telephone | 8602893375 |
| Practice Fax Number | 8607835733 |
| Mailing Telephone | 8602893375 |
| Mailing Fax Number | 8607835733 |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2009-11-23 |
| Authorized Official Name | DR. WILLIAM J. GLUCKSMAN (PRESIDENT) |
| Authorized Official Telephone | 8602893375 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | Y |
| Parent Organization Name | JEFFERSON RADIOLOGY, PC |
| Parent Organization TIN |
|
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 004000295 | 05 | |
| CT | CONNECTICARE | 669045 | 01 |
| CT | OXFORD | A2516306 | 01 |
| CT | CIGNA | S9999 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518158419 | Jefferson Radiology, PC | Nuclear Medicine | 23b Arts Center Ct, Avon, CT 06001 | 2007-08-06 |
| 1467403741 | Jefferson Radiology, PC | Radiology | 941 Farmington Ave, West Hartford, CT 06107-2203 | 2006-05-12 |
| 1538451042 | Jefferson Radiology, PC | Radiology | 74 Mack St, Windsor, CT 06095-2759 | 2011-05-03 |
| 1417112962 | Jefferson Radiology, PC | Radiology | 85 Seymour St, Suite 200, Hartford, CT 06106-5501 | 2008-07-24 |
| 1609067503 | Jefferson Radiology, PC | Nuclear Medicine | 40 Dale Rd, Avon, CT 06001-3692 | 2007-08-06 |
| 1285685867 | Jefferson Radiology, PC | Radiology | 1260 Silas Deane Hwy, Suite 104, Wethersfield, CT 06109-4362 | 2006-05-16 |
| 1396795951 | Jefferson Radiology, PC | Nuclear Medicine | 85 Seymour St Ste 200, Hartford, CT 06106-5509 | 2006-05-12 |
| 1053362350 | Jefferson Radiology, PC | Nuclear Medicine | 704 Hebron Ave, Suite 100, Glastonbury, CT 06033-5020 | 2006-05-12 |
| 1760463038 | Jefferson Radiology, PC | Radiology | 6 Northwestern Dr, Suite 102, Bloomfield, CT 06002-3463 | 2005-11-14 |
| Street Address |
18 E GRANBY RD |
| City | GRANBY |
| State | CT |
| Zip Code | 06035-2201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043315203 | Betty Kupracz | Internal Medicine | 18 E Granby Rd, Granby, CT 06035-2201 | 2006-09-13 |
| 1790914075 | Farmington Valley Orthopedic Associates PC | Orthopaedic Surgery | 18 E Granby Rd, Granby, CT 06035-2201 | 2009-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801348214 | Granby Pharmacy LLC | Pharmacy | 9 Hartford Avenue, Granby, CT 06035 | 2016-11-02 |
| 1851625271 | Melissa Marie Masse | Registered Nurse | 20 Bank Street, Granby, CT 06035 | 2009-10-01 |
| 1194937797 | Hope Goldstein | Physical Therapist | 18 E. Granby Road, Granby, CT 06035 | 2007-05-04 |
| 1801918909 | Michael A Ungerleider | Dentist | 41 Hartford Ave, Granby, CT 06035 | 2007-04-06 |
| 1801927058 | Kenneth Edward Endres | Dentist | 33 Hartford Avenue, Box 330, Granby, CT 06035 | 2007-03-08 |
| 1104921956 | Connecticut Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 20 Bank St, Granby, CT 06035 | 2006-09-14 |
| 1154426377 | Michele Twigg | Internal Medicine | 18 E. Granby Rd, 1st Floor, Granby, CT 06035 | 2006-09-13 |
| 1063517282 | Joseph Maglio | Internal Medicine | 18 East Granby Road, 1st Floor, Granby, CT 06035 | 2006-09-13 |
| 1184727992 | John Scott Hitchiner | Chiropractor | 50 Hartford Ave, Granby, CT 06035 | 2006-09-07 |
| 1174531446 | Jean M Keating | Pharmacist | 9 Hartford Ave, Granby, CT 06035 | 2006-08-03 |
| Find all providers in zip 06035 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
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|---|---|---|---|---|
| 1336781236 | Waterford Vascular Associates, P.C. | Radiology | 903 Hartford Tpke Unit 30, Waterford, CT 06385-4264 | 2019-10-11 |
| 1437700531 | Fairfield Interventional and Vascular Specialists PC | Radiology | 1 Sasco Hill Rd Ste 2, Fairfield, CT 06824-5670 | 2019-09-20 |
| 1356813505 | Northeast Radiology of Connecticut, LLC | Radiology | 40 Old Ridgebury Rd Ste 103, Danbury, CT 06810-5119 | 2018-12-28 |
| 1760964001 | Integrated Health Administrative Services, Inc. | Radiology | 1011 Hope St Ofc E, Stamford, CT 06907-2121 | 2018-09-04 |
| 1538682760 | Christina Prete | Radiology | 350 S Cherry St, Wallingford, CT 06492-4429 | 2017-07-19 |
| 1003361320 | Susan Nally | Radiology | 445 Hogan Rd, Hamden, CT 06518-1927 | 2016-08-16 |
| 1275987802 | Farmington Imaging Center, LLC | Radiology | 399 Farmington Ave Lowr 1, Farmington, CT 06032-1937 | 2016-04-20 |
| 1023498805 | Northeast Radiology of Connecticut, LLC | Radiology | 67 Sand Pit Rd Ste 101, Danbury, CT 06810-4032 | 2015-06-05 |
| 1538550546 | Mandell & Blau Md's PC | Radiology | 201 North Mountain Road, Plainville, CT 06062 | 2015-02-12 |
| 1407268543 | Jason Riley Jones | Radiology | 333 Cedar St., Room Te2, Ynhh- Dept of Radiology, New Haven, CT 06520-8042 | 2014-05-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.