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DR. JILL M BANATOSKI MD

>> Internal Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1982760542

Individual Registrant:
DR. JILL M BANATOSKI MD
Gender: F
Not Sole Proprietor

Location and contact information for practice:
5 PEQUOT PARK RD SUITE 301 WESTBROOK, CT 06498-2856 US
Tel: 860-399-6167  Fax: 860-399-6730

Contact information for business:
5 PEQUOT PARK RD SUITE 301 WESTBROOK, CT 06498-2856 US
Tel: 860-399-6167  Fax: 860-399-6730

Registration Information:
NPI: 1982760542
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207R00000XAllopathic & Osteopathic Physicians
Internal Medicine
CT036865

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
STATE LICENSE NUMBER036865CT01
FEDERAL DEABB586667901




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