Healthcare Provider Details

I. General information

NPI: 1679920003
Provider Name (Legal Business Name): JIANLIANG MAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NEWELL RD STE D28
BRISTOL CT
06010-5128
US

IV. Provider business mailing address

25 NEWELL RD STE D28
BRISTOL CT
06010-5128
US

V. Phone/Fax

Practice location:
  • Phone: 860-582-1220
  • Fax: 860-582-6255
Mailing address:
  • Phone: 860-582-1220
  • Fax: 860-582-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number077546
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number077546
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: