Provider Demographics
NPI:1437265808
Name:BROOKS, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BROOKS
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 1:166 CHERRY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-4828
Mailing Address - Country:US
Mailing Address - Phone:203-323-7331
Mailing Address - Fax:203-324-7027
Practice Address - Street 1:166 CHERRY ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4828
Practice Address - Country:US
Practice Address - Phone:203-323-7331
Practice Address - Fax:203-324-7027
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
200001064Medicare ID - Type Unspecified
H56929Medicare UPIN