Provider Demographics
NPI:1497822605
Name:JAMBOR, CLINTON ARMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:ARMIN
Last Name:JAMBOR
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 1:34 DALE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3659
Mailing Address - Country:US
Mailing Address - Phone:860-677-0079
Mailing Address - Fax:860-677-4785
Practice Address - Street 1:34 DALE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-677-0079
Practice Address - Fax:860-677-4785
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043505174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1435058Medicaid
CT200001093Medicare ID - Type Unspecified
CT1435058Medicaid