Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 781 | CT |
N | 222Z00000X | Podiatrist | 781 | CT |
N | 213EP1101X | Primary Podiatric Medicine | 781 | CT |
Y | 213ES0103X | Foot & Ankle Surgery | 781 | CT |
NPI | 1629089024 |
---|---|
Provider Name | Dr. Jonathan Jackson Key |
First Address | Hamden, CT 06518-3209 |
Second Address | Essex, CT 06426-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 24/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U97617 | (02) | CT |