Healthcare Provider Details

I. General information

NPI: 1053581868
Provider Name (Legal Business Name): JENNIFER G. JOSE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 BOSTON POST RD
DARIEN CT
06820-4717
US

IV. Provider business mailing address

688 BOSTON POST RD
DARIEN CT
06820-4717
US

V. Phone/Fax

Practice location:
  • Phone: 203-662-9602
  • Fax:
Mailing address:
  • Phone: 203-662-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number037301
License Number StateCT

VIII. Authorized Official

Name: DR. JENNIFER G JOSE
Title or Position: DR
Credential: MD
Phone: 203-662-9602