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General NPI Number Information
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NPI Number | 1790036465
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Entity Type | Organization
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Legal Business Name | JJJ HEALTH, LLC
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 30 MOULTON ST
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City | NEWTON
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State | MA
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Zip | 02462-1404
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Country | US
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Telephone | 617-244-5758
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Fax |
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Provider Business Mailing Address
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Address Line | 30 MOULTON ST
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City | NEWTON
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State | MA
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Zip | 02462-1404
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JENNIFER TJIA
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Credential | MD
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Telephone | 617-244-5758
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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 | 154059
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License Number State | MA
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