Healthcare Provider Details

I. General information

NPI: 1871087619
Provider Name (Legal Business Name): IBIS HEALTH SERVICES-NEW HAMPSHIRE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HEATHROW CT
NASHUA NH
03063-1524
US

IV. Provider business mailing address

215 AYER RD UNIT 797
HARVARD MA
01451-5033
US

V. Phone/Fax

Practice location:
  • Phone: 603-664-4800
  • Fax: 207-401-2727
Mailing address:
  • Phone: 603-664-4800
  • Fax: 207-401-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY M JANKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 603-921-4947