Provider Demographics
NPI:1063532596
Name:NEW HAVEN PUBLIC SCHOOLS
Entity type:Organization
Organization Name:NEW HAVEN PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CEBALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA, MPH
Authorized Official - Phone:203-234-9317
Mailing Address - Street 1:54 MEADOW ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1783
Mailing Address - Country:US
Mailing Address - Phone:203-946-8969
Mailing Address - Fax:203-946-8664
Practice Address - Street 1:54 MEADOW ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1783
Practice Address - Country:US
Practice Address - Phone:203-946-8969
Practice Address - Fax:203-946-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPENDING261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V1232OtherHEALTH NET PROVIDER ID
CT166185OtherVALUE OPTIONS PROVIDER NO