Healthcare Provider Details

I. General information

NPI: 1790710986
Provider Name (Legal Business Name): JOHN E MULLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KENT RD
NEW MILFORD CT
06776-3485
US

IV. Provider business mailing address

131 KENT RD
NEW MILFORD CT
06776-3485
US

V. Phone/Fax

Practice location:
  • Phone: 860-355-8000
  • Fax:
Mailing address:
  • Phone: 860-355-8000
  • Fax: 860-350-6291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number040380
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: