1427100957 NPI number — YALE NEW HAVEN HOSPITAL

Table of content: JENNIFER GALE CRISMOND OTL (NPI 1700023611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427100957 NPI number — YALE NEW HAVEN HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YALE NEW HAVEN HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427100957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 YORK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06504-8900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 YORK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06504-8900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-688-2046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MESSINA
Authorized Official First Name:
MARY
Authorized Official Middle Name:
GERETTE
Authorized Official Title or Position:
DIRECTOR, REGULATORY REIMBURSEMENT
Authorized Official Telephone Number:
203-688-8543

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  0044 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004041836 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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