Healthcare Provider Details

I. General information

NPI: 1992108757
Provider Name (Legal Business Name): JENNIFER L ALDRICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L ALDRICH PA-C

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ROBBINS ST
WATERBURY CT
06708-2613
US

IV. Provider business mailing address

64 ROBBINS ST
WATERBURY CT
06708-2613
US

V. Phone/Fax

Practice location:
  • Phone: 203-573-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3211
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: