Provider Demographics
NPI:1467424168
Name:TENCER, JEFFREY M (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:TENCER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ANGLERS BND
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1088
Mailing Address - Country:US
Mailing Address - Phone:860-409-0871
Mailing Address - Fax:860-673-1929
Practice Address - Street 1:1055 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1511
Practice Address - Country:US
Practice Address - Phone:860-409-0871
Practice Address - Fax:860-673-1929
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000594213E00000X
CAE3335213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030000594CT01OtherBLUE CROSS BLUE SHIELD
CT4125169Medicaid
CTHAS475OtherOXFORD HEALTH PLAN
CTOV1137OtherHEALTHNET
CT030000594CT01OtherBLUE CROSS BLUE SHIELD