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General NPI Number Information
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NPI Number | 1043785363
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Entity Type | Organization
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Legal Business Name | ANDREW S JUSKO MD PC
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Dates
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Enumeration Date | 10/13/2018
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Last Update Date | 10/13/2018
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Provider Practice Location Address
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Address Line | 299 CAREW ST STE 201
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City | SPRINGFIELD
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State | MA
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Zip | 01104-2360
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Country | US
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Telephone | 413-736-1833
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Fax |
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Provider Business Mailing Address
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Address Line | 382 N MAIN ST STE 101
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City | EAST LONGMEADOW
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State | MA
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Zip | 01028-1830
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Country | US
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Telephone | 413-525-8601
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW S JUSKO
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Credential | MD
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Telephone | 413-736-1833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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