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General NPI Number Information
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NPI Number | 1649395781
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Entity Type | Organization
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Legal Business Name | YALE NEW HAVEN AMBULATORY SERVICES CORP
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 229 GEORGE STREET FLOOR 3
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City | NEW HAVEN
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State | CT
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Zip | 06510
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Country | US
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Telephone | 203-498-3203
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Fax | 203-498-3107
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Provider Business Mailing Address
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Address Line | 229 GEORGE STREET FLOOR 3
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City | NEW HAVEN
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State | CT
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Zip | 06510
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Country | US
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Telephone | 203-498-3203
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Fax | 203-498-3107
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | RICHARD STAHL
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Credential | MD
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Telephone | 203-688-1311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0002
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License Number State | CT
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