Healthcare Provider Details

I. General information

NPI: 1811817471
Provider Name (Legal Business Name): RUSSELL JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 WASHINGTON ST
NORWICH CT
06360-2740
US

IV. Provider business mailing address

88 CIRILLO DR
COLCHESTER CT
06415-1889
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-8331
  • Fax:
Mailing address:
  • Phone: 860-944-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: