Healthcare Provider Details

I. General information

NPI: 1255422523
Provider Name (Legal Business Name): GEORGE M HAYNER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/13/2017
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

PO BOX 208058
NEW HAVEN CT
06520-8058
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2815
  • Fax: 203-737-8035
Mailing address:
  • Phone: 203-500-3851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number584
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number584
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: