Provider Demographics
NPI:1346446069
Name:JAB, INC.
Entity Type:Organization
Organization Name:JAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BISSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-863-0107
Mailing Address - Street 1:64 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1417
Mailing Address - Country:US
Mailing Address - Phone:802-863-0107
Mailing Address - Fax:802-658-9292
Practice Address - Street 1:64 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1417
Practice Address - Country:US
Practice Address - Phone:802-863-0107
Practice Address - Fax:802-658-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty