Provider Demographics
NPI:1790170033
Name:YALE-NEW HAVEN HOSPITAL
Entity Type:Organization
Organization Name:YALE-NEW HAVEN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AQUILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-688-2606
Mailing Address - Street 1:20 YORK STREET - DENTAL
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3202
Mailing Address - Country:US
Mailing Address - Phone:203-688-1288
Mailing Address - Fax:203-688-4461
Practice Address - Street 1:1 LONG WHARF DR
Practice Address - Street 2:SUITE 403
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-688-3000
Practice Address - Fax:203-688-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-03
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0441223D0004X, 1223P0221X, 1223X0400X, 124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008058656Medicaid