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General NPI Number Information
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NPI Number | 1053581868
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Entity Type | Organization
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Legal Business Name | JENNIFER G. JOSE MD LLC
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Dates
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Enumeration Date | 03/07/2008
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Last Update Date | 03/07/2008
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Provider Practice Location Address
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Address Line | 688 BOSTON POST RD
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City | DARIEN
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State | CT
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Zip | 06820-4717
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Country | US
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Telephone | 203-662-9602
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Fax |
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Provider Business Mailing Address
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Address Line | 688 BOSTON POST RD
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City | DARIEN
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State | CT
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Zip | 06820-4717
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Country | US
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Telephone | 203-662-9602
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Fax |
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Authorized Official
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Title or Position | DR
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Name | DR. JENNIFER G JOSE
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Credential | MD
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Telephone | 203-662-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 037301
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License Number State | CT
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