1609812080 NPI number — JODY ELIZABETH NAVITSKY MD

Table of content: JODY ELIZABETH NAVITSKY MD (NPI 1609812080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609812080 NPI number — JODY ELIZABETH NAVITSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAVITSKY
Provider First Name:
JODY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609812080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 PHOENIX AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
WATERBURY
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06702-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-756-8021
Provider Business Mailing Address Fax Number:
203-596-9038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 NEW BRITAIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-547-0970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  043718 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A929500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".