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General NPI Number Information
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NPI Number | 1699820787
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Entity Type | Individual
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Provider Name | JENS ERIK HAERTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 57 NORTH STREET DANBURY COMMUNITY HEALTH CENTER
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City | DANBURY
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State | CT
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Zip | 06810
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Country | US
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Telephone | 203-743-0100
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ORCHARD LN
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City | RIDGEFIELD
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State | CT
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Zip | 06877-5519
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Country | US
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Telephone | 203-460-0948
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 001309
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License Number State | CT
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