Healthcare Provider Details

I. General information

NPI: 1477191492
Provider Name (Legal Business Name): EMMA DZAMKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 MAIN ST STE 2
EAST HAMPTON CT
06424-1146
US

IV. Provider business mailing address

1013 WASHINGTON WOODBURY RD
ROXBURY CT
06783-1201
US

V. Phone/Fax

Practice location:
  • Phone: 860-440-7288
  • Fax:
Mailing address:
  • Phone: 203-518-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: