1669402343 NPI number — DR. JEAN CARL JARDA M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669402343 NPI number — DR. JEAN CARL JARDA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARDA
Provider First Name:
JEAN CARL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1669402343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
595 RIDGEWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06457-1950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-635-1441
Provider Business Mailing Address Fax Number:
860-635-1454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28-2 SHUNPIKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROMWELL
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-635-1441
Provider Business Practice Location Address Fax Number:
860-635-1454
Provider Enumeration Date:
07/05/2006

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: 2084P0802X , with the licence number:  029551 , 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)