Individual
JAKE PARKER WALLACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
70 MAIN ST, DANBURY, CT 06810-6099
(203) 739-8100
Mailing address
68 PEPPERIDGE DR, SOUTHINGTON, CT 06489-4416
(860) 919-4994
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/01/2025
Last updated
04/08/2025
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