Healthcare Provider Details

I. General information

NPI: 1417936022
Provider Name (Legal Business Name): WILLIAM EUGENE HELLENBRAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK ST.
NEW HAVEN CT
06520
US

IV. Provider business mailing address

P.O. BOX 208064 333 CEDAR ST.
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2022
  • Fax: 203-737-2786
Mailing address:
  • Phone: 203-785-2022
  • Fax: 203-737-2786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number214108
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number015288
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: