Healthcare Provider Details

I. General information

NPI: 1972719011
Provider Name (Legal Business Name): JOHN PETER SEIBYL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 TEMPLE ST SUITE 8B
NEW HAVEN CT
06510-2716
US

IV. Provider business mailing address

14 WILFORD AVE
BRANFORD CT
06405-3823
US

V. Phone/Fax

Practice location:
  • Phone: 203-401-4300
  • Fax:
Mailing address:
  • Phone: 203-488-7982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number029212
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: