Healthcare Provider Details

I. General information

NPI: 1285837401
Provider Name (Legal Business Name): NEW HAVEN WALK IN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 GRAND AVE
NEW HAVEN CT
06513-3906
US

IV. Provider business mailing address

77 GRAND AVE
NEW HAVEN CT
06513-3906
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-8697
  • Fax: 203-562-1822
Mailing address:
  • Phone: 203-562-8697
  • Fax: 203-562-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number034112
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number034112
License Number StateCT

VIII. Authorized Official

Name: MALLICK QAISER ALAM
Title or Position: PHYSICIAN IN CHARGE
Credential:
Phone: 203-562-8697