Healthcare Provider Details

I. General information

NPI: 1912540964
Provider Name (Legal Business Name): RACHEL JANKOVSKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 11/15/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 COLUMBUS BLVD
HARTFORD CT
06106-1976
US

IV. Provider business mailing address

60 ORANGE TER
WEST HAVEN CT
06516-1514
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-5619
  • Fax:
Mailing address:
  • Phone: 203-605-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number024404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: