Healthcare Provider Details

I. General information

NPI: 1306865407
Provider Name (Legal Business Name): JONAS LIEPONIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 BROAD ST
MILFORD CT
06460-3226
US

IV. Provider business mailing address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 203-433-0906
  • Fax: 203-453-3081
Mailing address:
  • Phone: 203-626-0160
  • Fax: 203-294-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number25632
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25632
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: