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General NPI Number Information
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NPI Number | 1528561800
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Entity Type | Organization
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Legal Business Name | INHOUSE MEDICAL LLC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 01/14/2024
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Provider Practice Location Address
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Address Line | 276 HIGHLAND AVE STE A2
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City | WATERBURY
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State | CT
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Zip | 06708-3022
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Country | US
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Telephone | 203-518-5232
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Fax | 888-372-6480
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Provider Business Mailing Address
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Address Line | 276 HIGHLAND AVE STE A2
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City | WATERBURY
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State | CT
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Zip | 06708-3022
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Country | US
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Telephone | 203-518-5232
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Fax | 888-372-6480
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Authorized Official
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Title or Position | OWNER
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Name | MR. STEVEN PAUL JESKE
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Credential | APRN
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Telephone | 203-518-5232
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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 |
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | CT
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Taxonomy #3
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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 | CT
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