Provider Demographics
NPI:1932322120
Name:LASSER, JAY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ANDREW
Last Name:LASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1031 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1511
Mailing Address - Country:US
Mailing Address - Phone:860-679-0473
Mailing Address - Fax:860-679-0475
Practice Address - Street 1:1031 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1511
Practice Address - Country:US
Practice Address - Phone:860-679-0473
Practice Address - Fax:860-679-0476
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0336862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010033686CT01OtherANTHEM