Active NPI
Jerry P Malefatto, MD
- Hematology & Oncology Physician
- Trumbull, CT
National Provider Identifier
1114011343
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- 031058
- Practice address
- 15 Corporate Drive
Trumbull, CT 06611 - Phone
- (203) 459-0262
- Fax
- (203) 459-0264
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician | 207RH0003X | 031058 | CT | Primary |
Addresses
Primary practice location
15 Corporate Drive
Trumbull, CT 06611
Mailing address
15 Corporate Drive
Trumbull, CT 06611
Phone (203) 459-0262
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25464 | Other | OXFORD | |
| 010031058CT01 | Other | CT | ANTHEM |
| 001310581 | Medicaid | CT | |
| 001410 | Other | HEALTHNET |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114011343",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 CORPORATE DRIVE",
"city": "TRUMBULL",
"state": "CT",
"postal_code": "06611",
"telephone_number": "203-459-0262",
"fax_number": "203-459-0264"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 CORPORATE DRIVE",
"city": "TRUMBULL",
"state": "CT",
"postal_code": "06611",
"telephone_number": "203-459-0262",
"fax_number": "203-459-0264"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALEFATTO",
"first_name": "JERRY",
"middle_name": "P",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RH0003X",
"taxonomy_group": "",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "CT",
"license": "031058",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "25464",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "010031058CT01",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001310581",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "001410",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Trumbull, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.