Individual
MR. JACQUES EDOUARD ETIENNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.A.P
Contact information
Practice address
205 MAIN ST. 1ST FL, OPTIMUM MEDICAL LLC, DANBURY, CT 06810
(203) 794-9000
(203) 794-9005
Mailing address
205 MAIN ST. 1ST FL, OPTIMUM MEDICAL LLC, DANBURY, CT 06810
(203) 794-9000
(203) 794-9005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
042829
CT
208000000X
Pediatrics Physician
233345-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008023919
—
CT
Enumeration date
07/04/2006
Last updated
05/11/2011
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