Healthcare Provider Details

I. General information

NPI: 1699936450
Provider Name (Legal Business Name): EDWARD ZUMAETA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 PINE ROCK AVE
HAMDEN CT
06514-4613
US

IV. Provider business mailing address

478 ORANGE ST
NEW HAVEN CT
06511-3870
US

V. Phone/Fax

Practice location:
  • Phone: 203-389-6230
  • Fax:
Mailing address:
  • Phone: 203-787-2207
  • Fax: 203-773-3626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: