Individual
MRS. JILL WASSERMAN GULLIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
950 CAMPBELL AVE, WEST HAVEN, CT 06516-2770
(203) 932-5711
Mailing address
501 KINGS HWY E, SUITE 112, FAIRFIELD, CT 06825-4867
(203) 382-1900
(203) 382-0019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
00773
CT
363AS0400X
Surgical Physician Assistant
000773
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290000773CT01
ANTHEM BLUE CROSS
CT
01
—
2V3798
HEALTH NET
CT
Enumeration date
05/23/2006
Last updated
09/11/2023
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