Healthcare Provider Details

I. General information

NPI: 1790436095
Provider Name (Legal Business Name): BJA INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 CATTLEMEN RD STE 300
SARASOTA FL
34232-6283
US

IV. Provider business mailing address

99 ROSEWOOD DR STE 245
DANVERS MA
01923-4537
US

V. Phone/Fax

Practice location:
  • Phone: 941-894-3742
  • Fax:
Mailing address:
  • Phone: 978-536-6141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVEN RUSSELL
Title or Position: CFO
Credential:
Phone: 770-330-7836