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NPI Code Detail

MEDICARE: JENNIFER GONZALEZ-STEPHENS P.A.

MEDICARE: JENNIFER GONZALEZ-STEPHENS P.A.
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
1363A00000XPhysician Assistant3016CT

General Provider Information

NPI Number : 1598194383
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GONZALEZ-STEPHENS P.A.
Provider Business Mailing Address
First Line : 1290 SILAS DEANE HWY
Second Line : HARTFORD HEALTHCARE-CVO
City : WETHERSFIELD
State : CT
Zip : 06109-4337
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 275 MOUNT CARMEL AVE
Second Line :
City : HAMDEN
State : CT
Zip : 06518-1961
Country : US
Telephone Number : 203-582-8742
Fax Number : 203-582-8924
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2013
Last Update Date : 06/17/2022

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