Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 022321 | CT |
NPI | 1063446698 |
---|---|
Provider Name | Jane Veronica Petroff |
First Address | Danbury, CT 06810-5627 |
Second Address | Danbury, CT 06810-5627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001223213 | (05) | CT |
B83839 | (02) | CT |