Provider Demographics
NPI:1588622591
Name:CENTRAL CONNECTICUT PATHOLOGY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:CENTRAL CONNECTICUT PATHOLOGY CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-224-5584
Mailing Address - Street 1:PO BOX 1730
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06507-1730
Mailing Address - Country:US
Mailing Address - Phone:203-397-8000
Mailing Address - Fax:203-389-1540
Practice Address - Street 1:100 GRAND ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2016
Practice Address - Country:US
Practice Address - Phone:860-224-5584
Practice Address - Fax:860-224-5946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14325207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V6399OtherHEALTHNET GRP#
CT500HBL433CT02OtherBC/BS BRADLEY GRP#
CT004199057P1OtherBLUE CARE GRP # NB
CT1104295OtherUNITED HEALTHCARE GRP#
CT4199057Medicaid
CT615577OtherCONNECTICARE GRP#
CT004199057P2OtherBLUE CARE GRP # BRADLEY
CT2215846OtherAETNA/USHC GRP#
CT500HBL433CT01OtherBC/CS NB GRP#
CT5154614OtherCIGNA GRP#
CT=========OtherOXFORD GROUP#
CT4199057Medicaid