Provider Demographics
NPI:1356350789
Name:JACOBS, HENRY ELI (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:ELI
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 NORTHWESTERN DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3400
Mailing Address - Country:US
Mailing Address - Phone:860-233-8589
Mailing Address - Fax:860-236-9636
Practice Address - Street 1:1 NORTHWESTERN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3400
Practice Address - Country:US
Practice Address - Phone:860-233-8589
Practice Address - Fax:860-236-9636
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT017368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001173681Medicaid
CT01017368OtherCIGNA
CT0029111OtherAETNA US HEALTHCARE
CT052270OtherHEALTH NET
CTHAP255OtherOXFORD
CT010017368CT01OtherBLUE SHIELD
CT030810OtherCONNECTICARE
CT0029111OtherAETNA US HEALTHCARE
B38155Medicare UPIN