Provider Demographics
NPI:1891212726
Name:JUSTIN D. CASKEY, D.O., P.C.
Entity Type:Organization
Organization Name:JUSTIN D. CASKEY, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:203-233-9977
Mailing Address - Street 1:67 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1630
Mailing Address - Country:US
Mailing Address - Phone:203-233-9977
Mailing Address - Fax:
Practice Address - Street 1:819 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2847
Practice Address - Country:US
Practice Address - Phone:203-758-1765
Practice Address - Fax:203-577-2116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT054213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty