Healthcare Provider Details

I. General information

NPI: 1477878262
Provider Name (Legal Business Name): AMANDA ELISABETH ZUBEK M.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ELISABETH BASS

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 STRAITS TPKE STE 306 YALE DERMATOLOGY-MIDDLEBURY
MIDDLEBURY CT
06762-1836
US

IV. Provider business mailing address

333 CEDAR ST YALE SCHOOL OF MEDICINE- DERMATOLOGY
NEW HAVEN CT
06520
US

V. Phone/Fax

Practice location:
  • Phone: 203-577-1050
  • Fax: 203-577-1053
Mailing address:
  • Phone: 203-785-4092
  • Fax: 203-785-7637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number53302
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: