Provider Demographics
NPI:1356329742
Name:NEW HAVEN SURGICAL ASSOCIATES,PC
Entity Type:Organization
Organization Name:NEW HAVEN SURGICAL ASSOCIATES,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:AMODEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-777-2376
Mailing Address - Street 1:136 SHERMAN AVE
Mailing Address - Street 2:SUITE # 308
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5238
Mailing Address - Country:US
Mailing Address - Phone:203-777-2376
Mailing Address - Fax:203-777-6916
Practice Address - Street 1:136 SHERMAN AVE
Practice Address - Street 2:SUITE # 308
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5238
Practice Address - Country:US
Practice Address - Phone:203-777-2376
Practice Address - Fax:203-777-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT20049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010020049CT01OtherBLUE SHIELD
CTOV3673OtherHELATHNET
CT1704128OtherUNITED HEALTH CARE
CTC007212OtherCHAMPUS
CT4266164OtherAETNA
CT010033084CT01OtherBLUE SHIELD
CT4534907OtherAETNA
CTNHS101OtherOXFORD
CTNHS100OtherOXFORD
CTOV3674OtherHEALTHNET
CT1704485OtherUNITED HEALTH CARE
CTOV3674OtherHEALTHNET
CT1704128OtherUNITED HEALTH CARE