Healthcare Provider Details

I. General information

NPI: 1487649463
Provider Name (Legal Business Name): ATLANTIC HEALTH SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PROSPECT ST
NEW HAVEN CT
06511-2181
US

IV. Provider business mailing address

1890 DIXWELL AVE SUITE 207
HAMDEN CT
06514-3122
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-6100
  • Fax: 203-773-8198
Mailing address:
  • Phone: 203-407-6444
  • Fax: 203-407-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFRY KLUGMAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 203-776-6100