Provider Demographics
NPI:1033391594
Name:HOSPITAL OF SAINT RAPHAEL
Entity Type:Organization
Organization Name:HOSPITAL OF SAINT RAPHAEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PGYI
Authorized Official - Prefix:
Authorized Official - First Name:WALID
Authorized Official - Middle Name:LABIB
Authorized Official - Last Name:SHAIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-278-2915
Mailing Address - Street 1:196 PARK ST APT 7
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4761
Mailing Address - Country:US
Mailing Address - Phone:203-278-2915
Mailing Address - Fax:
Practice Address - Street 1:196 PARK ST APT 7
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4761
Practice Address - Country:US
Practice Address - Phone:203-278-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care