Healthcare Provider Details

I. General information

NPI: 1255340634
Provider Name (Legal Business Name): YALE NEW HAVEN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

10 LAKEVIEW AVE APT #2
SHELTON CT
06484-2312
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2318
  • Fax:
Mailing address:
  • Phone: 203-926-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License Number001537
License Number StateCT

VIII. Authorized Official

Name: MS. JULIE MARISSA QUARTUCCIO
Title or Position: PA-C IN NBSCU
Credential: PA-C
Phone: 203-688-2318