NPI Code Detail JSON Logo

1598110215 NPI number — CANDICE G JERSEY D.O

NPI Number: 1598110215
Health Care Provider/Practitioner: CANDICE G JERSEY D.O

Information about “1598110215” NPI (CANDICE G JERSEY D.O) exists in 1598110215 in HTML format HTML  |  1598110215 in plain Text format TXT  |  1598110215 in PDF (Portable Document Format) PDF  |  1598110215 in an XML format XML  formats.

NPI Number : 1598110215 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598110215",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JERSEY",
    "FirstName": "CANDICE",
    "MiddleName": "G",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "D.O",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WILLIAMS",
    "OtherFirstName": "CANDICE",
    "OtherMiddleName": "G",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "D.O.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "263 FARMINGTON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FARMINGTON",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06030-0002",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "860-679-2147",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "263 FARMINGTON AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FARMINGTON",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06030-1530",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-679-2147",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/02/2016",
    "LastUpdateDate": "02/13/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208000000X",
          "TaxonomyName": "Pediatrics Physician",
          "LicenseNumber": "63814",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.