Individual
JACQUELINE J LITTZI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
125 MAIN ST, NEW CANAAN, CT 06840-5507
(203) 966-4200
Mailing address
31 CROSS RIDGE RD, NEW CANAAN, CT 06840-2312
(203) 966-4200
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
032333
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010032333CT02
ANTHEM IS ID NUMBER
CT
01
—
032333
STATE LICENSE
CT
01
—
061343834
STATE TAX ID
CT
01
—
125633
AETNA INS PROVIDER NUMBER
CT
01
—
ZS750
OXFORD INS ID NUMBER
CT
Enumeration date
12/12/2006
Last updated
01/04/2019
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