Healthcare Provider Details

I. General information

NPI: 1114312469
Provider Name (Legal Business Name): YALE-NEW HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 HOWARD AVE DANA 2
NEW HAVEN CT
06519-1304
US

IV. Provider business mailing address

20 YORK STREET - DENTAL
NEW HAVEN CT
06510-3020
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2464
  • Fax: 203-688-1426
Mailing address:
  • Phone: 203-688-1288
  • Fax: 203-688-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0044
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number0044
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number0044
License Number StateCT

VIII. Authorized Official

Name: MR. RICHARD D'AQUILLA
Title or Position: PRESIDENT
Credential:
Phone: 203-688-2606