Basic Information
| Provider Information | |||||||||
| NPI: | 1801961966 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HENKIND | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1275 SUMMER ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033244100 | ||||||||
| FaxNumber: | 2039691271 | ||||||||
| Practice Location | |||||||||
| Address1: | 1275 SUMMER ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069055359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033244100 | ||||||||
| FaxNumber: | 2039691271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 11/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 033602 | CT | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 010033602CT02 | 01 | CT | BLUE CROSS-DARIEN | OTHER | 022288 | 01 | CT | HEALTHNET | OTHER | 06-0873781 | 01 | CT | HUMANA CHOICECARE | OTHER | 10441096 | 01 | CT | CAQH | OTHER | 673756 | 01 | CT | CONNECTICUTCARE | OTHER | 06-0873781 | 01 | CT | CIGNA | OTHER | 06-0873781 | 01 | CT | UNITED | OTHER | ZP337 | 01 | CT | OXFORD | OTHER | 001336024 | 05 | CT | MEDICAID | 4492865 | 01 | CT | AETNA | OTHER | 010033602CT01 | 01 | CT | BLUE CROSS-STAMFORD | OTHER | 06-0873781 | 01 | CT | GREAT WEST | OTHER | 06-0873781 | 01 | CT | NORTHEAST HEALTHCARE ALLI | OTHER | 06-0873781 | 01 | CT | PHCS | OTHER |