Healthcare Provider Details

I. General information

NPI: 1275718777
Provider Name (Legal Business Name): QUINNIPIAC INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-7500
  • Fax: 203-287-7509
Mailing address:
  • Phone: 203-287-7500
  • Fax: 203-287-7509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number033256
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number005600
License Number StateCT

VIII. Authorized Official

Name: EDWARD RIPPEL
Title or Position: PRESIDENT, CEO
Credential: M.D.
Phone: 203-287-7500