Provider Demographics
NPI:1932371945
Name:ABRAHAM YALE & CAROL CALLAHAN PTRS ASSOCIATED PODIATRISTS OF N HAVEN
Entity Type:Organization
Organization Name:ABRAHAM YALE & CAROL CALLAHAN PTRS ASSOCIATED PODIATRISTS OF N HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAMBARDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-787-3800
Mailing Address - Street 1:12 VILLAGE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3828
Mailing Address - Country:US
Mailing Address - Phone:203-787-3800
Mailing Address - Fax:203-787-0004
Practice Address - Street 1:12 VILLAGE ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3828
Practice Address - Country:US
Practice Address - Phone:203-787-3800
Practice Address - Fax:203-787-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000283213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT480021954OtherRAIL ROAD PTAN
CT480021832OtherRAIL RAOD PTAN
CT480021954OtherRAIL ROAD PTAN
CTDH1621Medicare PIN
CTC00773Medicare PIN