Provider Demographics
NPI:1043247570
Name:YALE NEW HAVEN AMBULATORY SERVICES CORP. - TEMPLE RADIOLOGY
Entity Type:Organization
Organization Name:YALE NEW HAVEN AMBULATORY SERVICES CORP. - TEMPLE RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BORGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-688-2999
Mailing Address - Street 1:60 TEMPLE ST
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-2716
Mailing Address - Country:US
Mailing Address - Phone:203-688-2111
Mailing Address - Fax:203-688-2727
Practice Address - Street 1:60 TEMPLE ST
Practice Address - Street 2:SUITE 5B
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2716
Practice Address - Country:US
Practice Address - Phone:203-688-2111
Practice Address - Fax:203-688-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTIDTF4700000Medicare ID - Type Unspecified