Healthcare Provider Details

I. General information

NPI: 1790170033
Provider Name (Legal Business Name): YALE-NEW HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LONG WHARF DR SUITE 403
NEW HAVEN CT
06511-5991
US

IV. Provider business mailing address

20 YORK STREET - DENTAL
NEW HAVEN CT
06510-3202
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-3000
  • Fax: 203-688-3050
Mailing address:
  • Phone: 203-688-1288
  • Fax: 203-688-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number044
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number044
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number044
License Number StateCT

VIII. Authorized Official

Name: MR. RICHARD D'AQUILLA
Title or Position: PRESIDENT
Credential:
Phone: 203-688-2606