Individual
JAVIER MOTTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
146 SAMSON ROCK DR, MADISON, CT 06443-3018
(203) 318-8000
Mailing address
146 SAMSON ROCK DR, MADISON, CT 06443-3018
(203) 318-8000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
25MP00195700
NJ
363A00000X
Physician Assistant
Primary
3176
CT
363A00000X
Physician Assistant
P53986
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P53986
LICENSE
NY
Enumeration date
10/19/2006
Last updated
07/24/2015
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