Healthcare Provider Details

I. General information

NPI: 1215861711
Provider Name (Legal Business Name): JESSICA MARCUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 STRAWBERRY HILL CT STE 4
STAMFORD CT
06902-2594
US

IV. Provider business mailing address

10 BROOKSIDE RD
NEW FAIRFIELD CT
06812-3616
US

V. Phone/Fax

Practice location:
  • Phone: 203-353-0000
  • Fax: 203-357-8109
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number843
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: