Provider Demographics
NPI:1225149214
Name:KORNBLUT, JEFFREY H (DC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:KORNBLUT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 W CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-2516
Mailing Address - Country:US
Mailing Address - Phone:203-877-7488
Mailing Address - Fax:203-783-9630
Practice Address - Street 1:4 W CLARK ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2516
Practice Address - Country:US
Practice Address - Phone:203-877-7488
Practice Address - Fax:203-783-9630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT701678OtherCONNECTICARE PROVIDER #
CTP395048OtherOXFORD PROVIDER #
CT050000884CT01OtherANTHEM BC/BS PROVIDER #
CTOV1665OtherHEALTHNET PROVIDER #
CTOV1665OtherHEALTHNET PROVIDER #