Healthcare Provider Details

I. General information

NPI: 1497835979
Provider Name (Legal Business Name): LUBNA PAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SARGENT DRIVE YALE FERTILITY CENTER, LONG WHARF MEDICAL CENTER
NEW HAVEN CT
06511
US

IV. Provider business mailing address

322 SAYBROOK RD
ORANGE CT
06477-3003
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4708
  • Fax: 203-764-5619
Mailing address:
  • Phone: 203-799-0356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number045769
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: