Healthcare Provider Details

I. General information

NPI: 1831196823
Provider Name (Legal Business Name): BJA INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 05/10/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 NORTHLAKE BLVD STE 1040
ALTAMONTE SPRINGS FL
32701
US

IV. Provider business mailing address

99 ROSEWOOD DR STE 245
DANVERS MA
01923-4537
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-1023
  • Fax: 866-830-4248
Mailing address:
  • Phone: 978-536-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberHCC4910
License Number StateFL

VIII. Authorized Official

Name: JANICE SHOCK
Title or Position: EVP CLINICAL OPERATIONS
Credential:
Phone: 214-532-3757