Healthcare Provider Details

I. General information

NPI: 1639144306
Provider Name (Legal Business Name): SEMEON G TSALBINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 GRAND AVE FAIR HAVEN COMMUNITY HEALTH CENTER
NEW HAVEN CT
06513
US

IV. Provider business mailing address

374 GRAND AVE FAIR HAVEN COMMUNITY HEALTH CENTER
NEW HAVEN CT
06513
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax: 203-777-8506
Mailing address:
  • Phone: 203-777-7411
  • Fax: 203-777-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number018634
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: