Provider Demographics
NPI:1295850204
Name:ASSOCIATED PODIATRISTS OF NORTH HAVEN
Entity Type:Organization
Organization Name:ASSOCIATED PODIATRISTS OF NORTH HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:YALE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:203-787-3800
Mailing Address - Street 1:83 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1704
Mailing Address - Country:US
Mailing Address - Phone:203-787-3800
Mailing Address - Fax:203-787-0004
Practice Address - Street 1:83 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473
Practice Address - Country:US
Practice Address - Phone:203-787-3800
Practice Address - Fax:203-787-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000283213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT6143510001Medicare NSC
CTC03758Medicare PIN
CTDH1621Medicare PIN