Provider Demographics
NPI:1205646825
Name:JANUSZEWSKI, ETHAN JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:JOSEPH
Last Name:JANUSZEWSKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 PATRICIA DR
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02019-1085
Mailing Address - Country:US
Mailing Address - Phone:508-282-1393
Mailing Address - Fax:
Practice Address - Street 1:118 PATRICIA DR
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02019-1085
Practice Address - Country:US
Practice Address - Phone:508-282-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1230400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical