Healthcare Provider Details

I. General information

NPI: 1508253998
Provider Name (Legal Business Name): SAMUEL J LAURENCIN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 HOWARD AVE
NEW HAVEN CT
06519-1369
US

IV. Provider business mailing address

47 COLLEGE ST
NEW HAVEN CT
06510-3209
US

V. Phone/Fax

Practice location:
  • Phone: 877-925-3637
  • Fax:
Mailing address:
  • Phone: 475-267-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number69456
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: