Healthcare Provider Details

I. General information

NPI: 1891778858
Provider Name (Legal Business Name): FERN BLUMENFELD-JAFFE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 BLACK ROCK AVE
BRIDGEPORT CT
06605-1200
US

IV. Provider business mailing address

471 BARNUM AVE
BRIDGEPORT CT
06608-2409
US

V. Phone/Fax

Practice location:
  • Phone: 203-337-5174
  • Fax: 203-337-5177
Mailing address:
  • Phone: 203-333-6864
  • Fax: 203-332-0376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number000045
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: