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General NPI Number Information
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NPI Number | 1396314266
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Entity Type | Organization
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Legal Business Name | JOSCO MEDICAL GROUP LLC
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 12 N MAIN ST STE 110
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1932
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Country | US
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Telephone | 860-337-9800
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Fax | 860-263-7329
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Provider Business Mailing Address
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Address Line | 12 NORTH MAIN STREET, SUITE 110
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1932
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Country | US
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Telephone | 608-337-9800
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Fax | 860-263-7329
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Authorized Official
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Title or Position | OWNER
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Name | JACQUELINE ORTIZ-SKENDERIDIS
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Credential |
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Telephone | 860-337-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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