MEDICARE: JACOB HEN JR. M.D.

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	2080P0214X	Pediatric Pulmonology Physician	020710	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992774384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB HEN JR. M.D.

Provider Business Mailing Address
First Line	:	5520 PARK AVE
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611
Country	:	US
Telephone Number	:	203-337-8600
Fax Number	:	203-372-0109

Provider Business Practice Location Address
First Line	:	5520 PARK AVE
Second Line	:	NEMG
City	:	TRUMBULL
State	:	CT
Zip	:	06611-3463
Country	:	US
Telephone Number	:	203-337-8600
Fax Number	:	203-372-0109

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	12/08/2014

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