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NPI Code Detail

MEDICARE: ADVANCED DERMATOLOGY CENTER, PC

MEDICARE: ADVANCED DERMATOLOGY CENTER, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician035267CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DB0248OTHERCTRAILROAD MEDICARE

General Provider Information

NPI Number : 1639160294
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED DERMATOLOGY CENTER, PC
Provider Business Mailing Address
First Line : 464 WOLCOTT RD
Second Line :
City : WOLCOTT
State : CT
Zip : 06716-2626
Country : US
Telephone Number : 203-879-6171
Fax Number : 203-879-1191
Provider Business Practice Location Address
First Line : 464 WOLCOTT RD
Second Line :
City : WOLCOTT
State : CT
Zip : 06716-2626
Country : US
Telephone Number : 203-879-6171
Fax Number : 203-879-1191
Authorized Official
Title or Position : PRESIDENT
Name : RONALD S JURZYK
Credential : MD
Telephone Number : 203-879-6171
Provider Enumeration Date : 11/02/2005
Last Update Date : 01/11/2010

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1215910922 — RONALD S. JURZYK MD
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Directions to “ADVANCED DERMATOLOGY CENTER, PC ” Practice Location

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