Basic Information
| Provider Information | |||||||||
| NPI: | 1417936022 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HELLENBRAND | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 208064 | ||||||||
| Address2: | 333 CEDAR ST. | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852022 | ||||||||
| FaxNumber: | 2037372786 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARK ST. | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852022 | ||||||||
| FaxNumber: | 2037372786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 11/17/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 214108 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | 015288 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 00561404 | 05 | NY | MEDICAID |