Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 000454 | CT |
N | 222Z00000X | Podiatrist | 000454 | CT |
N | 213EP1101X | Primary Podiatric Medicine | 000454 | CT |
Y | 213ES0103X | Foot & Ankle Surgery | 000454 | CT |
NPI | 1083727556 |
---|---|
Provider Name | James M Dejesus |
First Address | Naugatuck, CT 06770-5033 |
Second Address | Naugatuck, CT 06770-5033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004083721 | (05) | CT |
T23117 | (02) |