=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598987679
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OBSTETRICS & GYNECOLOGY OF NORTH HAVEN, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 01/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 CHAPEL ST
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-8602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-248-4461
-----------------------------------------------------
Fax | 203-288-6761
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1435 CHAPEL ST
-----------------------------------------------------
City | NEW HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06511-8602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-248-4461
-----------------------------------------------------
Fax | 203-288-6761
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. CRAIG R HUTTLER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 203-248-4461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------