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NPI Code Detail

MEDICARE: DR. IRVIN R JENNINGS MD

MEDICARE: DR. IRVIN R JENNINGS MD
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
12084P0800XPsychiatry Physician0015203CT
22084P0804XChild & Adolescent Psychiatry Physician0015203CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1010015203CT01OTHERANTHEM BLUE CROSS BLUE SH
2203644OTHERMHN

General Provider Information

NPI Number : 1629141379
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IRVIN R JENNINGS MD
Provider Business Mailing Address
First Line : 75 WEST ST
Second Line :
City : DANBURY
State : CT
Zip : 06810-6528
Country : US
Telephone Number : 203-748-5689
Fax Number : 203-790-8183
Provider Business Practice Location Address
First Line : 75 WEST ST
Second Line :
City : DANBURY
State : CT
Zip : 06810-6528
Country : US
Telephone Number : 203-748-5689
Fax Number : 203-790-8183
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2006
Last Update Date : 09/11/2025

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