Jenna Russell Dallinga, LMT

Primary specialty

SpecialistTaxonomy code 174400000X

License

005456 Issued in CT

Practice address

40 Lake Avenue Ext
Danbury, CT 06811-5283

Phone

(845) 612-9849

NPI assigned

Mar 27, 2012

Last updated

Mar 27, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332806400000",
    "number": "1053687715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 HARVEST DR",
            "city": "BREWSTER",
            "state": "NY",
            "postal_code": "105093706",
            "telephone_number": "845-612-9849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 LAKE AVENUE EXT",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068115283",
            "telephone_number": "845-612-9849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALLINGA",
        "first_name": "JENNA",
        "middle_name": "RUSSELL",
        "name_prefix": "Ms.",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-27",
        "last_updated": "2012-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CT",
            "license": "005456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Danbury, CT
• Providers in Danbury, CT by specialty
• Specialist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.