Provider Demographics
NPI:1023205358
Name:JENKINS, GREGORY JUDE (PA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JUDE
Last Name:JENKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-276-7022
Mailing Address - Fax:203-276-5560
Practice Address - Street 1:1 HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-276-7022
Practice Address - Fax:203-276-5560
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00187900363AS0400X
CT2406363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
121223PF5Medicare PIN