Provider Demographics
NPI:1598987679
Name:OBSTETRICS & GYNECOLOGY OF NORTH HAVEN, P.C.
Entity Type:Organization
Organization Name:OBSTETRICS & GYNECOLOGY OF NORTH HAVEN, P.C.
Other - Org Name:GENERATIONS OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUTTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-248-4461
Mailing Address - Street 1:1435 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-8602
Mailing Address - Country:US
Mailing Address - Phone:203-248-4461
Mailing Address - Fax:203-288-6761
Practice Address - Street 1:1435 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-8602
Practice Address - Country:US
Practice Address - Phone:203-248-4461
Practice Address - Fax:203-288-6761
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS OB/GYN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1710171939OtherMEDICARE NPI
CT50JASISMDCT01OtherANTHEM GROUP ID
CTC01389OtherMEDICARE PTAN
CT50OBSTGYNCT01OtherANTHEM BLUE CROSS
CT50OBSTGYNCT01OtherANTHEM BLUE CROSS