Provider Demographics
NPI:1205867900
Name:TORNATORE, JEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:TORNATORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 MILL HILL AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-2826
Mailing Address - Country:US
Mailing Address - Phone:203-336-7353
Mailing Address - Fax:
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:NORTHEAST MEDICAL GROUP, INC.
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213067207V00000X
CT54417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213067OtherSTATE LICENSE
NYBT8007913OtherDEA NUMBER
NYBT8007913OtherDEA NUMBER