Provider Information for 1316525074
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SUSANNA JOSEY
Sex: Female
NPI: 1316525074
Last Updated: 2024-08-23
Certification Date: 2024-08-23
Certification Date: 2024-08-23
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316525074 | ||||||||||||||||
| Enumeration Date | 2021-04-01 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8082 United States Phone: 860-679-4477 | Fax:860-679-1025 | ||||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8082 United States Phone: 860-679-4477 | Fax:860-679-1025 | ||||||||||||||||
| Secondary Practice Address(es) | 24 HOSPITAL AVE | ||||||||||||||||
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