Healthcare Provider Details

I. General information

NPI: 1619934130
Provider Name (Legal Business Name): LORI JENSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 VALLEY DR STE 201
GREENWICH CT
06831-5205
US

IV. Provider business mailing address

15 VALLEY DR STE 201
GREENWICH CT
06831-5205
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-4490
  • Fax:
Mailing address:
  • Phone: 203-863-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number039546
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: