Provider Demographics
NPI:1851587034
Name:JONATHAN H. TRESS M.D. LLC
Entity Type:Organization
Organization Name:JONATHAN H. TRESS M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:TRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-548-9293
Mailing Address - Street 1:100 RETREAT AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2528
Mailing Address - Country:US
Mailing Address - Phone:860-548-9293
Mailing Address - Fax:860-548-9933
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-548-9293
Practice Address - Fax:860-548-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT26116207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03105Medicare PIN