=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467424168
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY M. TENCER DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 FARMINGTON AVE
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-1511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-409-0871
-----------------------------------------------------
Fax | 860-673-1929
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 ANGLERS BND
-----------------------------------------------------
City | UNIONVILLE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06085-1088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-409-0871
-----------------------------------------------------
Fax | 860-673-1929
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 000594
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | E3335
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------