Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 029894 | CT |
NPI | 1063458859 |
---|---|
Provider Name | Mr. Jared B Zelman |
First Address | Lakeville, CT 06039 |
Second Address | Sharon, CT 06069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 16/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B67715 | (02) |