Provider Demographics
NPI:1841856721
Name:NEMEC, JUTTA
Entity type:Individual
Prefix:
First Name:JUTTA
Middle Name:
Last Name:NEMEC
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 1:9 MEADOW PL.
Mailing Address - Street 2:N/A
Mailing Address - City:OLD GREENWICH,
Mailing Address - State:CT
Mailing Address - Zip Code:06870-2114
Mailing Address - Country:US
Mailing Address - Phone:203-637-3546
Mailing Address - Fax:
Practice Address - Street 1:9 MEADOW PL
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-2114
Practice Address - Country:US
Practice Address - Phone:203-637-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
104909OtherAMERICAN ACADEMY OF PEDIATRICS
104909OtherAMERICAN ACADEMY OF