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General NPI Number Information
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NPI Number | 1578460051
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Entity Type | Organization
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Legal Business Name | PN109 COMPANY LLC
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Dates
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Enumeration Date | 10/20/2026
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Last Update Date | 10/20/2026
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Provider Practice Location Address
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Address Line | 15901 COLLINS AVE APT 1704
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160
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Country | US
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Telephone | 860-832-4664
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Fax | 860-832-4665
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Provider Business Mailing Address
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Address Line | 11 WYNGATE DR
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City | AVON
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State | CT
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Zip | 06001
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Country | US
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Telephone | 860-832-4664
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Fax | 860-832-4665
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH AFERSON
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Credential | MD
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Telephone | 860-202-6642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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