Provider Demographics
NPI:1497317192
Name:YALE SURGICAL ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:YALE SURGICAL ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CPO
Authorized Official - Phone:203-996-3878
Mailing Address - Street 1:627 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6992
Mailing Address - Country:US
Mailing Address - Phone:203-777-2396
Mailing Address - Fax:
Practice Address - Street 1:627 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6992
Practice Address - Country:US
Practice Address - Phone:203-777-2396
Practice Address - Fax:203-777-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies