Healthcare Provider Details

I. General information

NPI: 1427347616
Provider Name (Legal Business Name): PHILIP R EFFRAIM MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR STREET TMP 3
NEW HAVEN CT
06520-8051
US

IV. Provider business mailing address

333 CEDAR STREET TMP 3
NEW HAVEN CT
06520-8051
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number54186
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: