Healthcare Provider Details

I. General information

NPI: 1205894607
Provider Name (Legal Business Name): FLORENCE IDA HSU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DEVINE ST STE 2B
NORTH HAVEN CT
06473-2222
US

IV. Provider business mailing address

333 CEDAR ST PO BOX 208013
NEW HAVEN CT
06520-8013
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-6200
  • Fax: 203-287-6101
Mailing address:
  • Phone: 203-785-4170
  • Fax: 203-785-3229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number49738
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number217989
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number217989
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number49738
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: