Healthcare Provider Details

I. General information

NPI: 1699767509
Provider Name (Legal Business Name): JEFFREY A SIMPSON MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MONTAUK AVE
NEW LONDON CT
06320-4738
US

IV. Provider business mailing address

345 MONTAUK AVE
NEW LONDON CT
06320-4738
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 Number001146
License Number StateCT

VIII. Authorized Official

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