Provider Demographics
NPI:1083727556
Name:DEJESUS, JAMES M (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:DEJESUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 NEW HAVEN RD
Mailing Address - Street 2:STE 10
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-5033
Mailing Address - Country:US
Mailing Address - Phone:203-723-7884
Mailing Address - Fax:203-723-2946
Practice Address - Street 1:1183 NEW HAVEN RD
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-5033
Practice Address - Country:US
Practice Address - Phone:203-723-7884
Practice Address - Fax:203-723-2946
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000454213E00000X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004083721Medicaid
CT004083721Medicaid
T23117Medicare UPIN
CT004083721Medicaid
CT480000413Medicare PIN
CT0520630003Medicare NSC