Healthcare Provider Details

I. General information

NPI: 1386824977
Provider Name (Legal Business Name): ZYGMUNT GOLEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-2212
US

IV. Provider business mailing address

110 WEST FLAT HILL RD.
SOUTHBURY CT
06488
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-4450
  • Fax: 860-679-1992
Mailing address:
  • Phone: 206-384-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA103289
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number045861
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: