Provider Demographics
NPI:1063499077
Name:JEAN, CHRISNEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISNEL
Middle Name:
Last Name:JEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 CHAPEL ST.
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511
Mailing Address - Country:US
Mailing Address - Phone:203-789-5946
Mailing Address - Fax:203-867-5287
Practice Address - Street 1:1450 CHAPEL ST.
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-5946
Practice Address - Fax:203-867-5287
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008292207P00000X
NY314805207P00000X
CT045753207P00000X
RIDO00643207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
MICI1999OtherRAILROAD GROUP
MICJ015026OtherBCBS
P00409602OtherRAILRAOD MEDICARE
MIM65410040Medicare UPIN
MIM65410040Medicare ID - Type Unspecified