Healthcare Provider Details

I. General information

NPI: 1285105023
Provider Name (Legal Business Name): CORRINE ZUKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 HAZARD AVE
ENFIELD CT
06082-4592
US

IV. Provider business mailing address

995 DAY HILL RD
WINDSOR CT
06095-1722
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-5020
  • Fax: 860-253-5030
Mailing address:
  • Phone: 860-697-3351
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: