Basic Information
| Provider Information | |||||||||
| NPI: | 1801884598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AFTEL | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3160 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064600960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037831831 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 HOSPITAL ROAD | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 06069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8603644141 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 01/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 032017 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 001157660 | 05 | CT | MEDICAID |