Provider Demographics
NPI:1861436735
Name:GIMBEL, JEFFREY HALE (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HALE
Last Name:GIMBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1807
Mailing Address - Country:US
Mailing Address - Phone:203-269-9400
Mailing Address - Fax:203-269-9455
Practice Address - Street 1:3 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1807
Practice Address - Country:US
Practice Address - Phone:203-269-9400
Practice Address - Fax:203-269-9455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037053207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001370535Medicaid
A61896Medicare UPIN
CT001370535Medicaid
CTD400022941Medicare PIN