Provider Demographics
NPI:1841320108
Name:NEW HAVEN NEUROSURGICAL ASSOC. P.C
Entity type:Organization
Organization Name:NEW HAVEN NEUROSURGICAL ASSOC. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:DICKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-772-4001
Mailing Address - Street 1:1570 BOSTON POST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2568
Mailing Address - Country:US
Mailing Address - Phone:203-772-4001
Mailing Address - Fax:203-772-4711
Practice Address - Street 1:1570 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2567
Practice Address - Country:US
Practice Address - Phone:203-772-4001
Practice Address - Fax:203-772-4711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004180717Medicaid