Provider Demographics
NPI:1740314061
Name:JOHNSON OCCUPATIONAL MEDICINE CENTER
Entity type:Organization
Organization Name:JOHNSON OCCUPATIONAL MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERDIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-763-7668
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:3 WEYMOUTH ROAD
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083-1153
Mailing Address - Country:US
Mailing Address - Phone:860-763-7668
Mailing Address - Fax:860-763-7676
Practice Address - Street 1:3 WEYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06083-1153
Practice Address - Country:US
Practice Address - Phone:860-763-7668
Practice Address - Fax:860-763-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010245OtherCONNECTICARE
CTP3201009OtherOXFORD
CT010023596CT11OtherANTHEM
CT2V4744OtherHEALTHNET
CT3015101OtherCIGNA
CTCU7369OtherHEALTHNET
CTE19462Medicare UPIN