Healthcare Provider Details

I. General information

NPI: 1588818694
Provider Name (Legal Business Name): ELIZABETH ANN HULINSKY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH ANN LIKINS-GRAHAM

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK ST CMHC
NEW HAVEN CT
06519
US

IV. Provider business mailing address

34 PARK ST FL 2
NEW HAVEN CT
06519-1109
US

V. Phone/Fax

Practice location:
  • Phone: 203-895-7663
  • Fax:
Mailing address:
  • Phone: 203-624-0673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001181
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001181
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: