Basic Information
| Provider Information | |||||||||
| NPI: | 1497982581 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHWARTZ | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 CEDAR ST | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065103206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8779253637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 POST RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068245730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2034189520 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2009 | ||||||||
| LastUpdateDate: | 09/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35122903 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | D85746 | MD | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 66665 | CT | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0102540 | 05 | OH | MEDICAID | P01420853 | 01 | OH | RAILROAD MEDICARE | OTHER |