Provider Demographics
NPI:1811026917
Name:DAY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAY
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 1:4 OLD MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:CT
Mailing Address - Zip Code:06424-1538
Mailing Address - Country:US
Mailing Address - Phone:860-267-2496
Mailing Address - Fax:860-267-0034
Practice Address - Street 1:4 OLD MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1538
Practice Address - Country:US
Practice Address - Phone:860-267-2496
Practice Address - Fax:860-267-0034
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12DME0616CT03OtherANTHEM
CT918786OtherCONNECTICARE
CT1301122OtherAETNA
CT12DME0616CT03OtherANTHEM