Provider Demographics
NPI:1184635237
Name:YALE PODIATRY GROUP PC
Entity Type:Organization
Organization Name:YALE PODIATRY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:YALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-734-4806
Mailing Address - Street 1:364 E MAIN ST
Mailing Address - Street 2:YALE PODIATRY GROUP PC
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1904
Mailing Address - Country:US
Mailing Address - Phone:203-734-4806
Mailing Address - Fax:203-734-8265
Practice Address - Street 1:364 E MAIN ST
Practice Address - Street 2:YALE PODIATRY GROUP PC
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1904
Practice Address - Country:US
Practice Address - Phone:203-734-4806
Practice Address - Fax:203-734-8265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4020517Medicaid
CT4020517Medicaid
CT0518450001Medicare NSC