Healthcare Provider Details

I. General information

NPI: 1215140850
Provider Name (Legal Business Name): JEFFREY A SIMPSON, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MONTAUK AVENUE
NEW LONDON CT
06320
US

IV. Provider business mailing address

345 MONTAUK AVENUE
NEW LONDON CT
06320
US

V. Phone/Fax

Practice location:
  • Phone: 860-444-6868
  • Fax: 860-437-0650
Mailing address:
  • Phone: 860-444-6868
  • Fax: 860-437-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number027396
License Number StateCT

VIII. Authorized Official

Name: DR. JEFFREY A SIMPSON
Title or Position: OWNER
Credential: MD
Phone: 860-444-6868