Healthcare Provider Details

I. General information

NPI: 1891759155
Provider Name (Legal Business Name): JOSEPH JR. BARTOSZEK JR. P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 NAEK RD HEALTH WISE MEDICAL ASSOCIATES SUITE 5
VERNON CT
06066
US

IV. Provider business mailing address

PO BOX 3249 HEALTH WISE MEDICAL ASSOCIATES
VERNON CT
06066-2149
US

V. Phone/Fax

Practice location:
  • Phone: 860-872-2289
  • Fax: 860-896-1425
Mailing address:
  • Phone: 860-872-2289
  • Fax: 860-896-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1347
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: