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General NPI Number Information
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NPI Number | 1740519883
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Entity Type | Organization
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Legal Business Name | DR. JEFFREY SMALL
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 4695 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1802
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Country | US
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Telephone | 203-372-4419
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Fax | 203-372-4919
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Provider Business Mailing Address
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Address Line | 4695 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1802
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Country | US
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Telephone | 203-372-4419
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Fax | 203-372-4919
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Authorized Official
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Title or Position | MD
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Name | JEFFREY DANIEL SMALL
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Credential |
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Telephone | 203-372-4419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | BS3578397
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License Number State | CT
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