Provider Demographics
NPI:1396314266
Name:JOSCO MEDICAL GROUP LLC
Entity type:Organization
Organization Name:JOSCO MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ-SKENDERIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-337-9800
Mailing Address - Street 1:12 NORTH MAIN STREET, SUITE 110
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-1932
Mailing Address - Country:US
Mailing Address - Phone:608-337-9800
Mailing Address - Fax:860-263-7329
Practice Address - Street 1:12 N MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-1932
Practice Address - Country:US
Practice Address - Phone:860-337-9800
Practice Address - Fax:860-263-7329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty