Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 962 | CT |
N | 222Z00000X | Podiatrist | 962 | CT |
N | 213E00000X | Podiatrist | E4858 | CA |
N | 222Z00000X | Podiatrist | E4858 | CA |
N | 213EP1101X | Primary Podiatric Medicine | 962 | CT |
N | 213EP1101X | Primary Podiatric Medicine | E4858 | CA |
N | 2081S0010X | Sports Medicine | E4858 | CA |
N | 213ES0000X | Sports Medicine | E4858 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | 962 | CT |
N | 213ES0103X | Foot & Ankle Surgery | E4858 | CA |
N | 213ES0131X | Foot Surgery | E4858 | CA |
NPI | 1306003850 |
---|---|
Provider Name | Dr. Jennifer Ann D'amico |
First Address | Torrington, CT 06790-3493 |
Second Address | Torrington, CT 06790-3493 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008073203 | (05) | CT |
CA126338 | MEDICARE PTAN NO CAL (01) | CA |
CB217729 | MEDICARE PTAN SO CAL (01) | CA |