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General NPI Number Information
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NPI Number | 1720214034
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Entity Type | Organization
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Legal Business Name | JOHNSON MEDICAL SPECIALISTS, PC
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 12/01/2009
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Provider Practice Location Address
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Address Line | 201 CHESTNUT HILL RD ATTN: LORI LADUE
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4005
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Country | US
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Telephone | 860-684-8415
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Fax |
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Provider Business Mailing Address
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Address Line | 201 CHESTNUT HILL RD
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City | STAFFORD SPRINGS
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State | CT
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Zip | 06076-4005
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Country | US
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Telephone | 860-684-8415
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES BIZILJ
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Credential | MD
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Telephone | 860-684-8125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | CT
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