Basic Information
| Provider Information | |||||||||
| NPI: | 1699765727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KIMMEL | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 ASYLUM AVE STE 2126 | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061051719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602530276 | ||||||||
| FaxNumber: | 8605471554 | ||||||||
| Practice Location | |||||||||
| Address1: | 113 ELM ST STE 302 | ||||||||
| Address2: | |||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060823739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032530276 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 031614 | CT | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 010031614CT01 | 01 | CT | ANTHEM / BCBS | OTHER |