Healthcare Provider Details

I. General information

NPI: 1174615017
Provider Name (Legal Business Name): SANDEEP KUMAR JOHAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CHASE PKWY
WATERBURY CT
06708-3346
US

IV. Provider business mailing address

500 CHASE PKWY
WATERBURY CT
06708-3346
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-6677
  • Fax:
Mailing address:
  • Phone: 203-755-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number049078
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number049078
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number049078
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: