Healthcare Provider Details

I. General information

NPI: 1609812080
Provider Name (Legal Business Name): JODY ELIZABETH NAVITSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW BRITAIN AVE
HARTFORD CT
06106
US

IV. Provider business mailing address

80 PHOENIX AVE STE 201
WATERBURY CT
06702-1418
US

V. Phone/Fax

Practice location:
  • Phone: 608-547-0970
  • Fax:
Mailing address:
  • Phone: 203-756-8021
  • Fax: 203-596-9038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number043718
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: