Individual
JEREMIAH JORDAN DECASTEELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
63 OHIO AVE, GROTON, CT 06340-6106
(631) 992-0705
Mailing address
63 OHIO AVE, GROTON, CT 06340-6106
(631) 992-0705
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CT
Other
Enumeration date
01/03/2024
Last updated
01/03/2024
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