Provider Demographics
NPI:1609857473
Name:ABBOSH, JASMINE M (MD)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:M
Last Name:ABBOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-232-9911
Mailing Address - Fax:860-233-5996
Practice Address - Street 1:836 FARMINGTON AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-232-9911
Practice Address - Fax:860-233-5996
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042394207K00000X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00142394600Medicaid
010042394CT01OtherBLUE CROSS
1714336OtherCIGNA
CT2V5485Medicaid
245572OtherPREFERRED ONE
P3240802OtherOXFORD
042394OtherCONNECTICARE
245572OtherPREFERRED ONE