Provider Demographics
NPI:1558621243
Name:TEMNOGOROD, JENNY (MD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:TEMNOGOROD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:YEWGENIA
Other - Middle Name:
Other - Last Name:TEMNOGOROD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:741 BROAD STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1347
Mailing Address - Country:US
Mailing Address - Phone:860-442-5663
Mailing Address - Fax:860-444-7778
Practice Address - Street 1:741 BROAD STREET EXT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1347
Practice Address - Country:US
Practice Address - Phone:860-442-5663
Practice Address - Fax:860-444-7778
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457290207W00000X
390200000X
CT56502207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008074527Medicaid