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General NPI Number Information
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NPI Number | 1164443990
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Entity Type | Organization
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Legal Business Name | LEDGEBROOK FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 6 LEDGEBROOK DR SUITE A
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1644
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Country | US
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Telephone | 860-456-1485
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Fax | 860-423-1589
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Provider Business Mailing Address
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Address Line | 6 LEDGEBROOK DR SUITE A
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City | MANSFIELD CENTER
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State | CT
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Zip | 06250-1644
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Country | US
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Telephone | 860-456-1485
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Fax | 860-423-1589
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Authorized Official
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Title or Position | DIRECTOR
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Name | DAVID A JAWORSKI
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Credential | MD
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Telephone | 860-456-1485
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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