Healthcare Provider Details

I. General information

NPI: 1235716176
Provider Name (Legal Business Name): LUKAS ZIBAITIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-1127
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-1921
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-3600
  • Fax: 860-679-1275
Mailing address:
  • Phone: 860-679-2147
  • Fax: 860-679-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number337096
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: