Unknown Individual – Diagnostic Radiology Physician, NPI 1063440428

Unknown Individual is a healthcare provider. based in Shelton, Connecticut. specializing in Diagnostic Radiology Physician. They hold a License No. 030801 (CT). The NPI Number for Unknown Individual is 1063440428

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1063440428
Phone
(203) 696-6125
Address
3 ENTERPRISE DR
Deactivation Date
29 November 2021

Doctor Profile

Medical School Name
NEW YORK MEDICAL COLLEGE
Secondary Phone
2035765067
Graduation Year
1983 (43 years ago)
PAC ID
9830116656
Group Practice PAC ID
0941291082
Professional Enrollment ID
I20051031000556
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 3, Enterprise Drive, Shelton, Naugatuck Valley Planning Region, Connecticut, 06484, United States

    SUITE 220

    SHELTON, CT 064847620

    Phone: (203) 696-6125

    Fax: (203) 696-6130

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $28.

Total Amount is formed as General ($28) + Research ($0) + Ownership ($0) = $28.

Last reported payment date: 2023-11-02 • Largest payer in this snapshot: Janssen Pharmaceuticals, Inc ($28).

Total Amount

$28

General + Research + Ownership

Payments

1

Total payment records

General Amount

$28

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-02

Latest reported date

Top Companies

Largest payers in this snapshot

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06484)

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Provider's Procedures

Unknown Individual performs procedures in Diagnostic Radiology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DIAGNOSTIC RADIOLOGYCT71250CT scan chest4141
DIAGNOSTIC RADIOLOGYCT73630X-ray of foot, minimum of 3 views5247
DIAGNOSTIC RADIOLOGYCT93971Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers4141

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0941291082View full group profile
NameSpecialtyState
Diagnostic RadiologyCT
Interventional Radiology, Diagnostic Radiology, Interventional Radiology, Diagnostic RadiologyCT
Diagnostic RadiologyCT
Diagnostic Radiology, Nuclear MedicineNC
Diagnostic RadiologyCT
Diagnostic Radiology, Nuclear MedicineCT
Diagnostic RadiologyCT
Diagnostic Radiology, Interventional RadiologyNJ
Diagnostic RadiologyCT
Diagnostic Radiology, Nuclear MedicineCA

Reviews

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Frequently asked questions

Does Unknown Individual share an NPI with anyone else?
NPI numbers are unique to each provider or organization — Unknown Individual uses 1063440428.
Why is Unknown Individual marked inactive in the NPI directory?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Diagnostic Radiology Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Shelton, Connecticut in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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