Healthcare Provider Details

I. General information

NPI: 1982331864
Provider Name (Legal Business Name): DR. JATIN KUKREJA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 PARK ST STE 1A
NEW HAVEN CT
06511-5474
US

IV. Provider business mailing address

95 CHESTER ST
HAMDEN CT
06514-3429
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7809
  • Fax:
Mailing address:
  • Phone: 860-938-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0016011
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: