Provider Demographics
NPI:1619037124
Name:LITTZI, JACQUELINE J
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:J
Last Name:LITTZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CROSS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-2312
Mailing Address - Country:US
Mailing Address - Phone:203-966-4200
Mailing Address - Fax:
Practice Address - Street 1:125 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-5507
Practice Address - Country:US
Practice Address - Phone:203-966-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032333207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT032333OtherSTATE LICENSE
CT010032333CT02OtherANTHEM IS ID NUMBER
CT061343834OtherSTATE TAX ID
CT125633OtherAETNA INS PROVIDER NUMBER
CTZS750OtherOXFORD INS ID NUMBER
CT010032333CT02OtherANTHEM IS ID NUMBER
CTZS750OtherOXFORD INS ID NUMBER