MS. MARYBETH HOLAK (NPI# 1518067230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518067230 |
| Entity Type | Individual |
| Full Name | MS. MARYBETH HOLAK |
| Credential | ARNP |
| Practice Address |
428 Columbus Avenue Dermatology New Haven CT 06519-1233 |
| Mailing Address |
400 Columbus Avenue Credentialing Specialist New Haven CT 06519-1233 |
| Practice Telephone | 2035033000 |
| Practice Fax Number | 2035033224 |
| Mailing Telephone | 2035033000 |
| Mailing Fax Number | 2035036515 |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2020-10-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
6944 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | 008075168 | 05 | |
| NH | ANTHEM BCBS | P61979 | 01 |
| NH | RAILROAD MEDICARE | P00067536 | 01 |
| Street Address |
428 COLUMBUS AVENUE DERMATOLOGY |
| City | NEW HAVEN |
| State | CT |
| Zip Code | 06519-1233 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285271072 | Lalida Long | Nurse Practitioner | 428 Columbus Avenue, Internal Medicine, New Haven, CT 06519-1233 | 2019-11-29 |
| 1851852339 | Isabella Yiroa Chen | Dentist | 428 Columbus Avenue, Dental, New Haven, CT 06519 | 2019-03-27 |
| 1528536745 | Viviana Angelina Ojeda | Dentist | 428 Columbus Avenue, Columbus Dental, New Haven, CT 06519-1233 | 2018-11-06 |
| 1982102083 | Jonathan Franklin Johnson Jr. | Registered Nurse | 428 Columbus Avenue, Pediatrics, New Haven, CT 06519-1233 | 2018-01-24 |
| 1558891531 | Matthew Zaringhalam | Internal Medicine | 428 Columbus Avenue, Convenient Care, New Haven, CT 06519-1233 | 2017-06-13 |
| 1376925370 | Shanique Bingham | Podiatrist | 428 Columbus Avenue, Podiatry, New Haven, CT 06519-1233 | 2015-06-25 |
| 1083093181 | Hadrian Holder | Family Medicine | 428 Columbus Avenue, New Haven, CT 06519-1233 | 2015-05-21 |
| 1891118204 | Theresa Pennachio | Marriage & Family Therapist | 428 Columbus Avenue, Child Family Guidance, New Haven, CT 06519-1233 | 2014-01-22 |
| 1801185996 | Amelia Watkins | Pediatrics | 428 Columbus Avenue, Cornell Scott-hill Health Center, New Haven, CT 06519-1233 | 2011-03-29 |
| 1619149515 | Jamil Ayanna Harp | Obstetrics & Gynecology | 428 Columbus Avenue, New Haven, CT 06519-1233 | 2008-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255819348 | Jordan Ficocelli | Nurse Practitioner | 800 Howard Ave # 2, New Haven, CT 06519 | 2018-08-01 |
| 1780123414 | Claire Louise Hardin | General Acute Care Hospital | 95 Howard Ave, New Haven, CT 06519 | 2017-02-14 |
| 1467809137 | Ana Laura Vives-rodriguez | Student in an Organized Health Care Education/Training Program | 800 Howard Avenue, Lower Level, Yale Physicians Building, New Haven, CT 06519 | 2016-05-23 |
| 1346607785 | Amanda Kayte Corcoran | Advanced Practice Midwife | 40 Prince St., Suite 207, New Haven, CT 06519 | 2016-01-15 |
| 1720491905 | Sara Harcharik Perkins | Dermatology | 2 Church St S Ste 305, New Haven, CT 06519 | 2014-06-05 |
| 1194136713 | Krishan Ratilal Jethwa | Radiology | 35 Park St Ste Ll507, New Haven, CT 06519 | 2014-05-16 |
| 1235549353 | Brandon Michael Kitay | Psychiatry & Neurology | 184 Liberty St # Lv108, New Haven, CT 06519 | 2014-04-28 |
| 1649526617 | Yale New Haven Hospital | Student in an Organized Health Care Education/Training Program | 330 Cedar St Fmb 107, Yale New Haven Hospital, Dept of Surgery, New Haven, CT 06519 | 2012-07-27 |
| 1669736765 | Mayanka Tickoo | Internal Medicine | 300 Cedar St Fl 4, New Haven, CT 06519 | 2012-07-03 |
| 1730441627 | Judith A Ross | Physical Therapist | 18 Tower Lane, Tower One Tower East, New Haven, CT 06519 | 2012-06-15 |
| Find all providers in zip 06519 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710502810 | Ashley Stier | Nurse Practitioner | 58516 River Oaks Drive, New Haven, MI 48048-3329 | 2020-06-15 |
| 1396368676 | You Ri Hwang | Nurse Practitioner | 1050 State St, New Haven, CT 06511-2762 | 2020-05-21 |
| 1346707460 | Corbin Health Services | Nurse Practitioner | 50 Brewery St Unit 9658, New Haven, CT 06536-0658 | 2019-02-25 |
| 1235656042 | Jennifer L Cornell | Nurse Practitioner | 333 Cedar St # 2073, New Haven, CT 06510-3206 | 2017-08-23 |
| 1609317080 | Deirdre Gruber | Nurse Practitioner | 54 Meadow St Fl 9, New Haven, CT 06519-1719 | 2017-03-17 |
| 1134666076 | Sharon Corbin | Nurse Practitioner | 635 Elm St, New Haven, CT 06511-4136 | 2017-01-31 |
| 1902285976 | Mary Sytek | Nurse Practitioner | 110 Hemlock Rd, New Haven, CT 06515-2618 | 2015-05-23 |
| 1053706499 | Suzanna Smaldone | Nurse Practitioner | 1427 Chapel St., Sanjay Aggarwal Md LLC, New Haven, CT 06511-4403 | 2015-04-02 |
| 1497155634 | Cheryl Maenza | Nurse Practitioner | 789 Howard Ave Bldg 3, New Haven, CT 06519-1304 | 2014-08-25 |
| 1881922482 | Chantelle Marie Shimono-legault | Nurse Practitioner | 330 Cedar St Tmp3, New Haven, CT 06510-3218 | 2009-11-20 |
| Find all providers in NEW HAVEN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.