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General NPI Number Information
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NPI Number | 1205843554
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Entity Type | Individual
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Provider Name | JON MICHAEL FESSEL MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 E MAIN STREET BUILDING 2 SUITE 3
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City | BRANFORD
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State | CT
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Zip | 06405
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Country | US
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Telephone | 203-488-2100
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Fax | 203-488-7400
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Provider Business Mailing Address
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Address Line | 246 CATHERINE TERRACE
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City | FAIRFIELD
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State | CT
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Zip | 06824
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Country | US
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Telephone | 203-259-3762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 013983
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License Number State | CT
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