Healthcare Provider Details

I. General information

NPI: 1134134018
Provider Name (Legal Business Name): ILJA HULINSKY MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 08/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 CAMPBELL AVE
WEST HAVEN CT
06516-3715
US

IV. Provider business mailing address

22 WESTWOOD DR
EASTON CT
06612-2123
US

V. Phone/Fax

Practice location:
  • Phone: 203-374-4490
  • Fax:
Mailing address:
  • Phone: 203-374-4490
  • Fax: 203-374-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number037019
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: