Provider Demographics
NPI:1245631126
Name:BONA VITA WELLNESS AND PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:BONA VITA WELLNESS AND PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOKSOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-283-3515
Mailing Address - Street 1:117B RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3315
Mailing Address - Country:US
Mailing Address - Phone:203-283-3515
Mailing Address - Fax:203-518-8008
Practice Address - Street 1:117B RIVER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-283-3515
Practice Address - Fax:203-518-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0489352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty