Provider Demographics
NPI:1457332298
Name:FACTOR, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:FACTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 FARMINGTON AVENUE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119
Mailing Address - Country:US
Mailing Address - Phone:860-232-9911
Mailing Address - Fax:860-233-5996
Practice Address - Street 1:836 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 207
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-232-9911
Practice Address - Fax:860-233-5996
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031434207K00000X, 207KI0005X
CT314342080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010031434CT01OtherBLUE CROSS
131576OtherPREFERRED ONE
00131434300OtherBLUE CROSS MEDICAID
CT001314343Medicaid
004394508OtherMEDICAID GROUP CAAC
0139300005OtherCIGNA
OS2162OtherHEALTHNET MEDICAID
P2666155OtherOXFORD
023998OtherCONNECTICARE
043518OtherAETNA