Healthcare Provider Details

I. General information

NPI: 1396722575
Provider Name (Legal Business Name): ALI VAEZY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST YNHH WEST PAVILION, 2ND FL
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST YNHH WEST PAVILION, 2ND FL
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4081
  • Fax: 203-737-2228
Mailing address:
  • Phone: 203-785-4081
  • Fax: 203-737-2228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number040741
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: