MEDICARE: JENNIFER DAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	918786	OTHER	CT	CONNECTICARE
2	12DME0616CT03	OTHER	CT	BC BS
3	1301122	OTHER	CT	AETNA

General Provider Information

NPI Number	:	1891963740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER DAY

Provider Business Mailing Address
First Line	:	4 OLD MARLBOROUGH RD
Second Line	:
City	:	EAST HAMPTON
State	:	CT
Zip	:	06424-1538
Country	:	US
Telephone Number	:	860-267-2496
Fax Number	:

Provider Business Practice Location Address
First Line	:	4 OLD MARLBOROUGH RD
Second Line	:
City	:	EAST HAMPTON
State	:	CT
Zip	:	06424-1538
Country	:	US
Telephone Number	:	860-267-2496
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER DAY
Credential	:
Telephone Number	:	860-267-2496

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/13/2008

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