Healthcare Provider Details

I. General information

NPI: 1902260755
Provider Name (Legal Business Name): JESSICA EPSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 W END AVE
OLD GREENWICH CT
06870-1642
US

IV. Provider business mailing address

8 W END AVE
OLD GREENWICH CT
06870-1642
US

V. Phone/Fax

Practice location:
  • Phone: 203-637-3212
  • Fax:
Mailing address:
  • Phone: 203-637-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number63878
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: