Provider Demographics
NPI:1952892630
Name:GLADSTEIN, JACLYN L (PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:L
Last Name:GLADSTEIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 SEYMOUR STREET
Mailing Address - Street 2:HARTFORD HOSPITAL SURGERY DEPT
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5037
Mailing Address - Country:US
Mailing Address - Phone:860-972-5022
Mailing Address - Fax:860-545-3266
Practice Address - Street 1:80 SEYMOUR STREET
Practice Address - Street 2:HARTFORD HOSPITAL SURGERY DEPT
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5037
Practice Address - Country:US
Practice Address - Phone:860-972-5022
Practice Address - Fax:860-545-3266
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT4142363AS0400X
MAPA8366363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical