Healthcare Provider Details

I. General information

NPI: 1841285509
Provider Name (Legal Business Name): JAY M GINSBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 NORWICH NEW LONDON TPKE SUITE #2
UNCASVILLE CT
06382-2518
US

IV. Provider business mailing address

88 NORWICH NEW LONDON TPKE SUITE #2
UNCASVILLE CT
06382-2518
US

V. Phone/Fax

Practice location:
  • Phone: 860-367-0087
  • Fax: 860-367-0117
Mailing address:
  • Phone: 860-367-0087
  • Fax: 860-367-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23310
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: