Provider Demographics
NPI:1396821716
Name:GREATER NEW HAVEN OB GYN GROUP PC
Entity Type:Organization
Organization Name:GREATER NEW HAVEN OB GYN GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:203-787-2264
Mailing Address - Street 1:2 CHURCH STREET SOUTH
Mailing Address - Street 2:209
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-787-2264
Mailing Address - Fax:203-787-5567
Practice Address - Street 1:2 CHURCH STREET SOUTH
Practice Address - Street 2:209
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-787-2264
Practice Address - Fax:203-787-5567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty