Basic Information
| Provider Information | |||||||||
| NPI: | 1255340634 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YALE NEW HAVEN HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 LAKEVIEW AVE | ||||||||
| Address2: | APT #2 | ||||||||
| City: | SHELTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064842312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039269399 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20 YORK ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036882318 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | QUARTUCCIO | ||||||||
| AuthorizedOfficialFirstName: | JULIE | ||||||||
| AuthorizedOfficialMiddleName: | MARISSA | ||||||||
| AuthorizedOfficialTitleorPosition: | PA-C IN NBSCU | ||||||||
| AuthorizedOfficialTelephone: | 2036882318 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 281PC2000X | 001537 | CT | Y | Hospitals | Chronic Disease Hospital | Children |
No ID Information.