Healthcare Provider Details

I. General information

NPI: 1619467867
Provider Name (Legal Business Name): MICHAEL SIDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK STREET YNHH PEDIATRICS
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

YALE NEW HAVEN HOSPITAL, DEPARTMENT OF PEDIATRICS 20 YORK STREET
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4242
  • Fax:
Mailing address:
  • Phone: 203-688-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME173745
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number68673
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: