Provider Demographics
NPI:1376815274
Name:THE HOSPITAL OF SAINT RAPHAEL
Entity Type:Organization
Organization Name:THE HOSPITAL OF SAINT RAPHAEL
Other - Org Name:SAINT RAPHAEL'S OCCUPATIONAL HEALTH PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTINE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:203-789-6079
Mailing Address - Street 1:84 N MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3061
Mailing Address - Country:US
Mailing Address - Phone:203-789-3666
Mailing Address - Fax:203-867-5253
Practice Address - Street 1:175 SHERMAN AVE
Practice Address - Street 2:5TH FL.
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4357
Practice Address - Country:US
Practice Address - Phone:203-789-3392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE HOSPITAL OF SAINT RAPHAEL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine