Provider Demographics
NPI:1609972819
Name:KLASS, JEFFREY J (ND)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:KLASS
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RANDI DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2440
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 DURHAM RD
Practice Address - Street 2:STE. B6 BLDG.2
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2076
Practice Address - Country:US
Practice Address - Phone:203-453-1906
Practice Address - Fax:203-453-2012
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT000058175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT739975OtherCONNECTICARE
CT110000058CT01OtherBLUE CROSS BLUE SHIELD
CTOR1938OtherHEALTHNET
CTP414392OtherOXFORD