Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 25907 | CT |
N | 207PE0004X | Emergency Medical Services | 25907 | CT |
NPI | 1073580874 |
---|---|
Provider Name | Dr. Andreas John Bojko |
First Address | Glastonbury, CT 06033-3936 |
Second Address | Manchester, CT 06040-4131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 18/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25907 | MEDICAL LICENSE (01) | CT |
E46251 | (02) | CT |