Basic Information
| Provider Information | |||||||||
| NPI: | 1629089024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEY | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | JACKSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M.,F.A.C.F.A.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2408 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | HAMDEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065183209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2036260160 | ||||||||
| FaxNumber: | 2032946734 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 BOKUM RD | ||||||||
| Address2: | |||||||||
| City: | ESSEX | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064261500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2039366677 | ||||||||
| FaxNumber: | 2038482391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 10/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 781 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | 213EP1101X | 781 | CT | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | 781 | CT | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.