Healthcare Provider Details

I. General information

NPI: 1225023203
Provider Name (Legal Business Name): JEFFRY KLUGMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PROSPECT ST
NEW HAVEN CT
06511-2181
US

IV. Provider business mailing address

1890 DIXWELL AVE SUITE 207
HAMDEN CT
06514-3122
US

V. Phone/Fax

Practice location:
  • Phone: 203-776-6100
  • Fax: 203-773-8198
Mailing address:
  • Phone: 203-407-6444
  • Fax: 203-407-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number016697
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: