Healthcare Provider Details

I. General information

NPI: 1598789653
Provider Name (Legal Business Name): JON J ERNSTOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 LEWIS AVE SUITE 106
MERIDEN CT
06451-2121
US

IV. Provider business mailing address

2139 SILAS DEANE HWY
ROCKY HILL CT
06067-2336
US

V. Phone/Fax

Practice location:
  • Phone: 203-886-0036
  • Fax: 203-886-0072
Mailing address:
  • Phone: 860-257-4131
  • Fax: 860-257-4519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number025772
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1022596
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number025772
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: