Provider Demographics
NPI:1720196413
Name:MARK JOSEL, M.D.,P.C.
Entity Type:Organization
Organization Name:MARK JOSEL, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-243-3344
Mailing Address - Street 1:4 NORTHWESTERN DRIVE
Mailing Address - Street 2:BLDG 4 STE #100
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002
Mailing Address - Country:US
Mailing Address - Phone:860-243-3344
Mailing Address - Fax:860-242-2804
Practice Address - Street 1:4 NORTHWESTERN DRIVE
Practice Address - Street 2:BLDG 4 STE #100
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-243-3344
Practice Address - Fax:860-242-2804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4234837Medicaid
=========OtherTAX
B39150Medicare UPIN
110008881Medicare ID - Type UnspecifiedDR CHEN
C02987Medicare PIN
F69627Medicare UPIN
CT4234837Medicaid