Healthcare Provider Details

I. General information

NPI: 1427614817
Provider Name (Legal Business Name): JESSICA FOERTSCH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2019
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 DANBURY RD
WILTON CT
06897-4427
US

IV. Provider business mailing address

55 DANBURY RD
WILTON CT
06897-4427
US

V. Phone/Fax

Practice location:
  • Phone: 203-762-3363
  • Fax: 631-376-3420
Mailing address:
  • Phone: 203-762-3363
  • Fax: 631-376-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71658
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: