Basic Information
| Provider Information | |||||||||
| NPI: | 1003078379 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOZZO | ||||||||
| FirstName: | YEISID | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 AMHERST DR | ||||||||
| Address2: | |||||||||
| City: | CHESHIRE | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064101606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032713935 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | DEPT OF NEONATOLOGY | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2008 | ||||||||
| LastUpdateDate: | 07/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080N0001X | 046618 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | 208000000X | 046618 | CT | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 98900-5912 | 01 | CT | CONNECTICARE | OTHER | 2V9573 | 01 | CT | HEALTHNET/COMMERCIAL | OTHER | P00359922 | 01 | CT | RR MEDICARE | OTHER | 290000989CT03 | 01 | CT | ANTHEM BCBS CT | OTHER | 1064653 | 01 | CT | USA | OTHER | 26-33542 | 01 | CT | AMERICHOICE | OTHER | 26-33542 | 01 | CT | UHC | OTHER | P3412840 | 01 | CT | OXFORD | OTHER | 357229 | 01 | CT | WELLCARE | OTHER | 7061719 | 01 | CT | AETNA | OTHER |