Provider Demographics
NPI:1114546967
Name:MORGAN, JAKE EDWARD
Entity Type:Individual
Prefix:MR
First Name:JAKE
Middle Name:EDWARD
Last Name:MORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2919
Mailing Address - Country:US
Mailing Address - Phone:203-927-8173
Mailing Address - Fax:
Practice Address - Street 1:53 HORSESHOE RD
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2919
Practice Address - Country:US
Practice Address - Phone:203-927-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program