Basic Information
Provider Information | |||||||||
NPI: | 1275791667 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LIAPAKIS | ||||||||
FirstName: | ANNMARIE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HUYSMAN | ||||||||
OtherFirstName: | ANNMARIE | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 208019 333 CEDAR ST/1080 L | ||||||||
Address2: | YALE DEPT OF INTERNAL MED SECTION OF DIGESTIVE DISEASES | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 065208019 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037856140 | ||||||||
FaxNumber: | 2037857273 | ||||||||
Practice Location | |||||||||
Address1: | 40 TEMPLE STREET, SUITE 1A | ||||||||
Address2: | YALE DIGESTIVE DISEASES TEMPLE MEDICAL CENTER | ||||||||
City: | NEW HAVEN | ||||||||
State: | CT | ||||||||
PostalCode: | 06510 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2037854138 | ||||||||
FaxNumber: | 2037371345 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/02/2008 | ||||||||
LastUpdateDate: | 07/02/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 51060 | CT | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0100X | 242595 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.