1689600561 NPI number — MR. LESZEK A KOLODZIEJCZAK MD

Table of content: MR. LESZEK A KOLODZIEJCZAK MD (NPI 1689600561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689600561 NPI number — MR. LESZEK A KOLODZIEJCZAK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOLODZIEJCZAK
Provider First Name:
LESZEK
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
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:
1689600561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 FOUNDERS ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
WILLIMANTIC
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06226-2050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-423-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
162 MANSFIELD AVE.
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
WILLIMANTIC
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-423-5000
Provider Business Practice Location Address Fax Number:
860-423-4838
Provider Enumeration Date:
06/23/2006

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: 208600000X , with the licence number:  032557 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010032557CT01 . This is a "ANTHEM BC / BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 030946 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001325572 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001325572 . This is a "BLUE CARE FAMILY PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0811232 . This is a "AETNA / US HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 9079072002 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P469467 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P04569 . This is a "CHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 767225 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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