MEDICARE: JENNIFER G. JOSE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305R00000X	Preferred Provider Organization	037301	CT

General Provider Information

NPI Number	:	1053581868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER G. JOSE LLC

Provider Business Mailing Address
First Line	:	1767 SUMMER ST STE 1
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5123
Country	:	US
Telephone Number	:	203-662-9602
Fax Number	:

Provider Business Practice Location Address
First Line	:	1767 SUMMER ST STE 1
Second Line	:
City	:	STAMFORD
State	:	CT
Zip	:	06905-5123
Country	:	US
Telephone Number	:	203-662-9602
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	JENNIFER G JOSE
Credential	:	MD
Telephone Number	:	203-662-9602

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	05/27/2026

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