Provider Demographics
NPI:1790796845
Name:YALE, JEFFREY F (DPM)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:F
Last Name:YALE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1904
Mailing Address - Country:US
Mailing Address - Phone:203-734-4806
Mailing Address - Fax:203-734-8265
Practice Address - Street 1:364 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1904
Practice Address - Country:US
Practice Address - Phone:203-734-4806
Practice Address - Fax:203-734-8265
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000231213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T23409Medicare UPIN