Healthcare Provider Details

I. General information

NPI: 1033391594
Provider Name (Legal Business Name): HOSPITAL OF SAINT RAPHAEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PARK ST APT 7
NEW HAVEN CT
06511-4761
US

IV. Provider business mailing address

196 PARK ST APT 7
NEW HAVEN CT
06511-4761
US

V. Phone/Fax

Practice location:
  • Phone: 203-278-2915
  • Fax:
Mailing address:
  • Phone: 203-278-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCT

VIII. Authorized Official

Name: WALID LABIB SHAIB
Title or Position: PGYI
Credential: M.D.
Phone: 203-278-2915