Bastion Medical Practice Of New Jersey PC
Urology in Farmington, CT. Organization (NPI-2).
NPI number1598529802
StatusActive
Last updated in NPPESFeb 7, 2024
Details
- NPI
- 1598529802
- Entity type
- Organization (NPI-2)
- Legal business name
- Bastion Medical Practice Of New Jersey PC
- Organization subpart
- No
- Enumeration date
- Feb 7, 2024
- Certification date
- Feb 7, 2024
- Last updated
- Feb 7, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208800000X | Urology | – | – | Yes |
Practice location
400 Farmington AveFarmington, CT 06032-1913
Phone 650-610-1617
Mailing address
400 Farmington AveFarmington, CT 06032-1913
Phone 650-610-1617
Authorized official
Vasanth Kainkaryam
President
7862200003
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