Provider Demographics
NPI:1811219801
Name:JEFFREY H GIMBEL MD LLC
Entity Type:Organization
Organization Name:JEFFREY H GIMBEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:GIMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-269-9400
Mailing Address - Street 1:PO BOX 864
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-0864
Mailing Address - Country:US
Mailing Address - Phone:203-269-9400
Mailing Address - Fax:203-269-9455
Practice Address - Street 1:50 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4219
Practice Address - Country:US
Practice Address - Phone:203-269-9400
Practice Address - Fax:203-269-9455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD100022940Medicare PIN