Healthcare Provider Details

I. General information

NPI: 1992619209
Provider Name (Legal Business Name): ERNEST MARSHALL KRAJCIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 ASPEN RISE
EAST GRANBY CT
06026-9413
US

IV. Provider business mailing address

26 ASPEN RISE
EAST GRANBY CT
06026-9413
US

V. Phone/Fax

Practice location:
  • Phone: 203-868-1612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberLNRE10020667
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: