Provider Demographics
NPI:1922042258
Name:YALE UNIVERSITY
Entity Type:Organization
Organization Name:YALE UNIVERSITY
Other - Org Name:YALE DERMATOPATHOLOGY LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESS-SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-785-2140
Mailing Address - Street 1:300 GEORGE ST
Mailing Address - Street 2:PO BOX 9805
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6624
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:15 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3221
Practice Address - Country:US
Practice Address - Phone:203-785-4094
Practice Address - Fax:203-785-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00413468Medicaid