Healthcare Provider Details

I. General information

NPI: 1982636106
Provider Name (Legal Business Name): JEFFREY ORELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BRIDGEPORT AVE
SHELTON CT
06484
US

IV. Provider business mailing address

19 LUNAR DRIVE
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-402-0638
  • Fax: 203-755-6263
Mailing address:
  • Phone: 203-389-7504
  • Fax: 203-389-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number023005
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: