Healthcare Provider Details

I. General information

NPI: 1528056561
Provider Name (Legal Business Name): SETH M POWSNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 TEMPLE ST SUITE 6-C
NEW HAVEN CT
06510-2715
US

IV. Provider business mailing address

40 TEMPLE ST SUITE 6-C
NEW HAVEN CT
06510-2715
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4085
  • Fax: 203-737-1597
Mailing address:
  • Phone: 203-785-4085
  • Fax: 203-737-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number026707
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number026707
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number026707
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: