Healthcare Provider Details

I. General information

NPI: 1396372488
Provider Name (Legal Business Name): LINDSAY MARIE EYSENBACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 CEDAR ST
NEW HAVEN CT
06510-3222
US

IV. Provider business mailing address

367 CEDAR ST
NEW HAVEN CT
06510-3222
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2644
  • Fax:
Mailing address:
  • Phone: 203-785-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberML61059315
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: