Provider Demographics
NPI:1114927332
Name:HELLREICH, JAY E (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:E
Last Name:HELLREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6600
Mailing Address - Country:US
Mailing Address - Phone:203-235-2511
Mailing Address - Fax:203-639-0809
Practice Address - Street 1:546 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6600
Practice Address - Country:US
Practice Address - Phone:203-235-2511
Practice Address - Fax:203-639-0809
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028996207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001289968Medicaid
CT0R0103OtherHEALTH NET
CT180008284OtherRAILROAD MEDICARE
CT010028996CT01OtherANTHEM
CTNHS396OtherOXFORD
CT028996OtherCONNECTICARE
CT028996OtherCONNECTICARE
CT001289968Medicaid