Healthcare Provider Details

I. General information

NPI: 1538953633
Provider Name (Legal Business Name): EUGENE KOBLIK RN BSN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

6 GARDEN PL
GREENWICH CT
06831-5009
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3566
  • Fax:
Mailing address:
  • Phone: 917-669-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number179050
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: