Healthcare Provider Details

I. General information

NPI: 1629100086
Provider Name (Legal Business Name): MARY L GARIBALDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY L BRASCH

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 06/26/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YALE NH HOSPITAL 20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

36 MARNE AVE
FAIRFIELD CT
06825-1755
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-4242
  • Fax:
Mailing address:
  • Phone: 518-423-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64005
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number64005
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: