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General NPI Number Information
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NPI Number | 1699796441
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Entity Type | Individual
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Provider Name | JEROME WILLIAM TAKIFF MD
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 06/11/2012
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Provider Practice Location Address
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Address Line | 895 EAST MAIN STREET
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City | TORRINGTON
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State | CT
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Zip | 06790
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Country | US
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Telephone | 860-489-1291
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Fax | 860-489-1804
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Provider Business Mailing Address
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Address Line | 895 EAST MAIN STREET
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City | TORRINGTON
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State | CT
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Zip | 06790
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Country | US
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Telephone | 860-489-1291
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Fax | 860-489-1804
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 21436
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 21436
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License Number State | CT
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