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General NPI Number Information
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NPI Number | 1053571133
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Entity Type | Individual
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Provider Name | JEROME DWUAN TAYLOR MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 330 CEDAR ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3218
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Country | US
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Telephone | 929-210-6160
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Fax | 929-210-6161
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Provider Business Mailing Address
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Address Line | 330 CEDAR ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3218
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Country | US
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Telephone | 929-210-6160
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Fax | 929-210-6161
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 231485
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 76946
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License Number State | CT
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