Provider Demographics
NPI:1790214518
Name:MJS MED LLC
Entity Type:Organization
Organization Name:MJS MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-446-4555
Mailing Address - Street 1:1243 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1737
Mailing Address - Country:US
Mailing Address - Phone:203-446-4555
Mailing Address - Fax:
Practice Address - Street 1:1243 S BROAD ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1737
Practice Address - Country:US
Practice Address - Phone:203-446-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty