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General NPI Number Information
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NPI Number | 1063963791
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Entity Type | Organization
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Legal Business Name | MIDDLESEX LABORATORY PHYSICIANS, LLC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 28 CRESCENT ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-3654
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Country | US
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Telephone | 860-358-6160
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1613
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City | NEW HAVEN
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State | CT
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Zip | 06506-1613
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Country | US
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Telephone | 860-358-6160
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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. JONATHAN D LEVINE
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Credential | M.D.
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Telephone | 860-358-6160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State | CT
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