Healthcare Provider Details

I. General information

NPI: 1528224755
Provider Name (Legal Business Name): ANN NAKAI JUREWICZ DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 03/07/2023
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GRAND AVE
NEW HAVEN CT
06513-3949
US

IV. Provider business mailing address

374 GRAND AVE
NEW HAVEN CT
06513-3733
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-7411
  • Fax: 203-777-8506
Mailing address:
  • Phone: 203-777-7411
  • Fax: 203-777-8506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number711
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006071
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1026
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: