Provider Demographics
NPI:1922576818
Name:GREATER NEW HAVEN ASC, LLC
Entity Type:Organization
Organization Name:GREATER NEW HAVEN ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORALUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-271-4254
Mailing Address - Street 1:2080 WHITNEY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3603
Mailing Address - Country:US
Mailing Address - Phone:833-271-4254
Mailing Address - Fax:203-745-2392
Practice Address - Street 1:2080 WHITNEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3603
Practice Address - Country:US
Practice Address - Phone:833-271-4254
Practice Address - Fax:203-745-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical