Provider Demographics
NPI:1922081157
Name:FENICK, ADA MINSKY (MD)
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:MINSKY
Last Name:FENICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9805
Mailing Address - Street 2:300 GEORGE ST, 6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:203-785-6414
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:YALE-NEW HAVEN HOSPITAL - BASEMENT
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-688-2470
Practice Address - Fax:203-688-7274
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2007-12-03
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Provider Licenses
StateLicense IDTaxonomies
CT041625208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45737Medicare UPIN