Healthcare Provider Details

I. General information

NPI: 1093862740
Provider Name (Legal Business Name): YALE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LOCK ST
NEW HAVEN CT
06511-3603
US

IV. Provider business mailing address

55 LOCK ST PO BOX 208237
NEW HAVEN CT
06511-3603
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-0076
  • Fax: 203-432-7289
Mailing address:
  • Phone: 203-432-0076
  • Fax: 203-432-7289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number0005
License Number StateCT

VIII. Authorized Official

Name: LISA MEROLA-GRIMM
Title or Position: ASSOCIATE DIRECTOR
Credential:
Phone: 203-432-0076