Healthcare Provider Details

I. General information

NPI: 1245724087
Provider Name (Legal Business Name): JMSTHERAPEUTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 BRADLEY RD UNIT 6
MADISON CT
06443-2662
US

IV. Provider business mailing address

71 BRADLEY RD UNIT 6
MADISON CT
06443-2662
US

V. Phone/Fax

Practice location:
  • Phone: 203-421-6242
  • Fax: 203-421-6808
Mailing address:
  • Phone: 203-421-6242
  • Fax: 203-421-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAY SEIGEL
Title or Position: MEMBER
Credential:
Phone: 203-421-6242