Individual
DR. JILL M BANATOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5 PEQUOT PARK RD, SUITE 301, WESTBROOK, CT 06498-2856
(860) 399-6167
(860) 399-6730
Mailing address
5 PEQUOT PARK RD, SUITE 301, WESTBROOK, CT 06498-2856
(860) 399-6167
(860) 399-6730
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036865
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036865
STATE LICENSE NUMBER
CT
Enumeration date
12/28/2006
Last updated
03/07/2023
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