Healthcare Provider Details

I. General information

NPI: 1598150609
Provider Name (Legal Business Name): WOJCIECH JUNGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 MAIN ST
GLASTONBURY CT
06033-2021
US

IV. Provider business mailing address

2377 MAIN ST STE E
GLASTONBURY CT
06033-2021
US

V. Phone/Fax

Practice location:
  • Phone: 860-430-2636
  • Fax: 860-413-0894
Mailing address:
  • Phone: 860-430-2636
  • Fax: 860-413-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number006072
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: