1093866626 NPI number — PAVEL STRAZNICKY MD

Table of content: PAVEL STRAZNICKY MD (NPI 1093866626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093866626 NPI number — PAVEL STRAZNICKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRAZNICKY
Provider First Name:
PAVEL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093866626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 MERIDEN AVE
Provider Second Line Business Mailing Address:
3E
Provider Business Mailing Address City Name:
SOUTHINGTON
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06489-3238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-628-2046
Provider Business Mailing Address Fax Number:
860-628-8154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
291 FRANKLIN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYCKOFF
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07481-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-847-0119
Provider Business Practice Location Address Fax Number:
201-847-0871
Provider Enumeration Date:
01/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MA04351800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: 025000 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)