Provider Demographics
NPI:1003949132
Name:WATSTEIN, GEORGE J (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:WATSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 YORK ST
Mailing Address - Street 2:SUITE 2 A
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5620
Mailing Address - Country:US
Mailing Address - Phone:203-624-6431
Mailing Address - Fax:203-624-6452
Practice Address - Street 1:100 YORK ST
Practice Address - Street 2:SUITE 2 A
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5620
Practice Address - Country:US
Practice Address - Phone:203-624-6431
Practice Address - Fax:203-624-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0144342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010014434CT01OtherANTHEM