Healthcare Provider Details

I. General information

NPI: 1356710040
Provider Name (Legal Business Name): BOND STREET PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 WALNUT TREE HILL RD
SANDY HOOK CT
06482-1073
US

IV. Provider business mailing address

68 WALNUT TREE HILL RD
SANDY HOOK CT
06482-1073
US

V. Phone/Fax

Practice location:
  • Phone: 203-257-3130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002370
License Number StateCT

VIII. Authorized Official

Name: JOHN MATTHEW LUJANAC
Title or Position: MEMBER
Credential: APRN
Phone: 203-257-3130