Healthcare Provider Details

I. General information

NPI: 1699820787
Provider Name (Legal Business Name): JENS ERIK HAERTER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 NORTH STREET DANBURY COMMUNITY HEALTH CENTER
DANBURY CT
06810
US

IV. Provider business mailing address

11 ORCHARD LN
RIDGEFIELD CT
06877-5519
US

V. Phone/Fax

Practice location:
  • Phone: 203-743-0100
  • Fax:
Mailing address:
  • Phone: 203-460-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001309
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: