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Physicians Surgery

Provider NPI: 1811910128

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
1450 CHAPEL ST  NEW HAVEN, CT 06511-4405 US
Tel: 475-227-7503  Fax: --

Business Mailing Address:
Tel: 845-454-0120  Fax: 845-454-8454

NPI Information:
NPI: 1811910128
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
N363AS0400XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363A00000X





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