Provider Demographics
NPI:1760656078
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 1:33 SUMMIT RIDGE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3911
Mailing Address - Country:US
Mailing Address - Phone:802-863-0107
Mailing Address - Fax:802-658-9292
Practice Address - Street 1:64 COLCHESTER AVENUE
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:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420005559208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT69852OtherBCBS