Healthcare Provider Details

I. General information

NPI: 1700254331
Provider Name (Legal Business Name): JACOB A. KAPPLAN NURSE ANESTHESIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CEDAR ST # ST3
NEW HAVEN CT
06510-3206
US

IV. Provider business mailing address

41 MALL RD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 860-972-2797
  • Fax:
Mailing address:
  • Phone: 781-744-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number089214
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number089214
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN2353222
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: