Organization
INTERNAL MEDICINE OF WEST HAVEN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIZELLE FLORES (CREDENTIALING MANAGER)
(860) 944-4766
Entity
Organization
Contact information
Practice address
764 CAMPBELL AVE, SUITE E, WEST HAVEN, CT 06516-3786
(203) 931-0034
(203) 931-8225
Mailing address
764 CAMPBELL AVE, WEST HAVEN, CT 06516-3786
(203) 931-0034
(203) 931-8225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001359844
—
CT
05
—
008080626
—
CT
Enumeration date
10/18/2007
Last updated
02/11/2025
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